Urgent & emergency care at Doncaster Royal Infirmary 'requires improvement'
That's according to a new report from the Care Quality Commission
The Care Quality Commission (CQC) has again rated urgent and emergency care at Doncaster Royal Infirmary, part of Doncaster and Bassetlaw Teaching NHS Foundation Trust, as requires improvement. It has also taken further action to protect people.
CQC carried out an inspection in December to follow up on concerns raised about the quality of care people were experiencing. Inspectors found breaches of regulation regarding safe care and treatment, premises and equipment, staffing and how the service is managed.
A follow-up inspection was undertaken in January to check what improvements had been made. Due to the lack of progress made, additional enforcement action was taken due to continued concerns regarding people’s safety within the department. The trust must send CQC an action plan explaining their assurances in making the necessary improvements.
Following the inspections, CQC has again rated effective, responsive and well-led as requires improvement, caring has changed from good to requires improvement, and safe has gone down from requires improvement to inadequate.
Chris Storton, CQC deputy director of operations in the north-east, said:
“When we inspected urgent and emergency care at Doncaster Royal Infirmary, we found staff were kind and working hard to meet people’s needs under considerable pressure. However, they weren’t always able to do so safely due to lengthy delays in people being seen and poor communication between teams.
“We saw long delays and spoke with several people who had been waiting too long without a full clinical assessment being carried out which placed them at risk of harm or deterioration.
“Staff told us there was no formalised plan in place for them to manage people in the waiting area, and healthcare assistants were often told to monitor people but didn’t feel they had the right level of expertise or training to do this safely. This mixed with overcrowding and poor oversight meant people could deteriorate quickly without being noticed by staff. Leaders must take action to support staff to address this.
“Several people had been waiting hours without being offered pain relief, including someone with a significant limb injury. Our inspectors raised these concerns urgently with leaders, and we were pleased that additional pain relief measures had been introduced when we reinspected in January.
“We have told leaders where we expect to see rapid and sustained improvements and will continue to monitor the service closely to keep people safe during this time. We have begun the process of taking regulatory action in order to protect people further.”
Inspectors found:
• Staff said communication and teamworking had deteriorated which affected the quality of care people received.
• The service required people to wait in areas that were close to busy entrances and doors and didn’t have personal care facilities close by.
• The trust didn’t have a designated pharmacist within the department, which wasn’t in line with guidance from The Royal College of Emergency Medicine.
• The service didn’t manage the treatment of people with suspected sepsis quick enough, due to issues with the prescription of antibiotics, leading to delays in treatment.
• Leaders hadn’t ensured medical staff received the correct level of safeguarding training required for their roles.
• Parts of the emergency department were unclean, with considerable amounts of dust and debris.
However:
• Staff were kind and caring and supported people to make decisions about their care and treatment.
• Staff ensured all relevant professionals were involved in people’s planning and care who had complex needs.
• Staff knew how to assess and care for people with mental health issues.
A spokesperson at Doncaster and Bassetlaw Teaching Hospitals said: “We know this will be concerning for our communities, and we take this seriously.
“Our focus is on ensuring care is delivered to a consistently high standard, so that every patient coming to our hospitals is assessed promptly, monitored appropriately, and any concerns are identified and escalated without delay.
“We recognise the work our colleagues carry out in a demanding environment. We also know there is more to be done to improve, and we are committed to ensuring teams have the right support in place to deliver the standard of care they want to provide.
“We know we can do better, and we will.”