QA hospital A&E and bed occupancy pressures
Next week, Portsmouth City Council’s health, overview and scrutiny panel will meet to discuss an update report
QA hospital is still struggling with bed capacity, which remains above 100 per cent, with escalation spaces and “corridor care” still being used.
Next week, Portsmouth City Council’s health, overview and scrutiny panel will meet to discuss an update report from Portsmouth Hospitals University Trust, which oversees Queen Alexandra Hospital in Cosham.
Emergency department (ED)
In July this year, the hospital’s ED waiting times improved slightly, with 72 per cent of patients receiving care and being discharged within four hours. On August 10, the trust exceeded its target of 75 per cent, achieving a validated performance of 78.7 per cent.
However, the hospital’s 12-hour performance “remains significantly challenged”. Since the last report, published in March, 1949 patients spent more than 12 hours in the ED, against a target of 1779.
Some 46 per cent of admitted patients spent more than 12 hours in the ED, compared with 2.4 per cent of non-admitted patients.
The report states that this highlights “continued pressure” on patient flow and bed availability in urgent and emergency care.
“Delayed discharges and bed capacity, workforce pressures and rising demand are all creating significant pressure on services.
“We are focusing our actions on patient flow, rapid assessment and operational oversight and expect to see improvement in our performance in this area.”
Ambulance handovers
The average ambulance handover, where custody of the patient is transferred from the ambulance to the hospital, remains on target.
On average, handovers take 14 minutes, against a plan of 16 minutes and 31 seconds.
In July this year, 38.5 per cent of handovers were completed within 15 minutes, against a target of 15 per cent.
The report adds that capacity and patient flow pressures have resulted in “persistent Emergency Department overcrowding and occupancy above safe operating levels”.
Despite this “directly impacts ambulance handover performances”, the trust is “pleased with the improvements in this area”.
Non-criteria to reside (NCTR)
The hospital has been dealing with pressures around bed occupancy, partly driven by patients who are medically fit but cannot leave hospital.
Bed occupancy remains a “significant challenge”, with overall occupancy at 109.2 per cent of core bed capacity, down slightly from 109.9 per cent. Medical bed occupancy is 114 per cent, an improvement from around 127.9 per cent earlier in the year.
High emergency demand continues to put pressure on ED and inpatient capacity, with overnight escalation areas and corridor care still being used.
The report adds that this increases the “risk of care being delivered in non-standard environments and reducing the Trust’s ability to manage future demand, including winter pressures”.
At the last scrutiny meeting, Simon Barson, COO of the trust, said NCTR patients are predominantly elderly.
The trust is focusing on several areas to improve bed capacity and patient flow. Integrated medicine, orthopaedics and surgery are working with analytics and improvement teams to identify actions and solutions.
An Outpatient Parenteral Antimicrobial Therapy pilot is due to start in early September. It will allow patients to receive IV antibiotics or other anti-infection medicines at home or in a daily clinic, rather than staying in hospital.
Planning for the winter
The trust is focusing on a winter resilience programme “focused on maintaining patient safety, improving patient flow, – Public – reducing ambulance handover delays, and ensuring timely access to urgent and elective care”.
A winter plan will help deliver a “co-ordinated approach that meet population needs” alongside a vaccination delivery programme, due to commence on October 1.
“Recruitment, training and competency sign-off of workplace vaccinators and bank vaccinators is currently underway, supported by a trustwide staff communications and engagement campaign, including targeted activity for staff groups and departments with historically lower vaccination uptake”.
Critical incident response
In June, the QA site declared a critical incident after several chiller units failed during an extreme heatwave.
High temperatures and humidity affected critical areas, including theatres, scanning facilities and digital infrastructure, leading to some planned procedures being postponed.
Thanks to staff efforts, the incident was resolved within a few days. Measures introduced since then have helped the site manage other heatwaves throughout the summer.