Bristol Royal Infirmary has been told it must improve after the Care Quality Commission (CQC) raised concerns over overcrowding, fire safety and patient care at weekends. The CQC has told the BRI, part of University Hospitals Bristol and Weston NHS Foundation Trust, to make improvements following an inspection in June. The service is also known as UHBW Bristol Campus.
An unannounced inspection of urgent and emergency services was carried after CQC received information of concern about some of the services being provided.
Following the inspection, the urgent and emergency service was re-rated as requires improvement overall, as were the ratings for safe and responsive. Effective and well-led were re-rated as good. This inspection didn’t rate how caring the service was, which remains as good.
The ratings for the BRI are unaffected by the results of this inspection, and remain rated as good overall. The overall rating for University Hospitals Bristol and Weston NHS Foundation Trust is also unaffected and remains as good.
In the report the CQC highlighted: “We found areas of concern in medical staffing and the safety of the environment in relation to overcrowding in the department and availability of trained fire wardens. There was a risk patient safety would be impacted by the reduced number of medical staff at weekends and that the service wouldn’t have access to a trained fire warden to manage an evacuation of the building in the event of a fire.”
It added: “We identified areas for improvement in relation to monitoring of the quality of handovers from the emergency department towards and compliance with venous thromboembolism (blood clot) risk assessments.
“There was a risk to the continuity of patient care and safety when patients moved areas and an increased risk of blood clots if risk assessments were not always completed on the observation unit. Use of information technology to support safe pathways and transitions was limited. We have asked the provider for an action plan in response to the concerns found at this assessment.”
The report also found records used in the department were a mix of paper and electronic. Junior medical staff commented that the hybrid notes system led to a significant duplication of work and made them less efficient.
Catherine Campbell, CQC deputy director of operations in the south, said: “During our inspection of Bristol Royal Infirmary, we found an emergency department which was often understaffed, especially at weekends, which led to delays for people needing care and treatment.
“Leaders didn’t monitor the quality of staff handovers from the emergency department to the wards. This meant there were missed opportunities for learning and to improve the future care of people being transferred on to inpatient wards.
“The trust also needs to improve how they are risk assessing and managing people who potentially have sepsis. A recent audit showed staff didn’t always identify and manage sepsis using the trust’s guidelines, which put people at risk.
“However, leaders had a strong awareness of the risks of managing the flow of people through the department and surges in demand. Staff also worked well together to deliver good care and worked with leaders collaboratively to improve the service.
“Ambulance handover times had improved, and staff worked together to manage the risks of overcrowding in the department.
“The trust leadership know what they must do to improve, and we will continue to monitor them to make sure people are safe whilst this is happening, as well as reinspecting to check on their progress.”
The CQC added that the service had rolled out a campaign in collaboration with another organisation to support staff to improve people’s journey from the emergency department, through to admission and discharge. Leaders had improved the availability of same day emergency care services to improve access to medical, frailty, cardiology, and surgery specialities.
Professor Deirdre Fowler, chief nurse and midwife at University Hospitals Bristol and Weston NHS Foundation Trust, said: “Patient safety is our top priority. We have taken immediate steps to address concerns the CQC have raised to ensure timeliness of treatment and the safety of those we serve.
“We welcome the CQC’s recognition that colleagues innovative and joined up approach to safety is maximising the effectiveness of people’s care, and treatment and are pleased that this is resulting in positive experiences and feedback from patients cared for at our Bristol emergency department.”
The report will be published on CQC’s website in the coming days.
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