We reviewed both the Emergency Department and Urgent Care Centre. These two services are co-located within the Hospital but the Urgent Care Centre is contracted to Greenbrook Healthcare (via Hounslow and Richmond Community Healthcare).
Patients walking into the department register first with the Urgent Care Centre and an Emergency Nurse Practitioner undertakes a clinical streaming assessment. Based on this the patient is either:
- treated in A&E (major illness/injury)
- treated in the UCC (minor illness/injury)
- re-directed to other health services e.g. GP
The department was clean and well presented. Patients were positive about the environment of the Department.
We raised concerns about a considerable number of broken seats and out of use for the duration of our week long review, because of this the Hospital has put additional seating in the Emergency Department waiting area.
63% of patients were positive about the clinical streaming process with compliments given to reception staff.
However patients were unclear what would happen after the assessment, therefore the provider will add announcements to the information TV screen and place signage in the waiting room.
Patients did not have adequate privacy and were not able to sit during the streaming assessment. As a result of our recommendation, side panels and a chair has been added to improve patient's comfort and privacy.
For patients sent to the ED it was not always clear that they needed to re-register at the ED reception. This caused frustration for some patients, and in one case a delay in treatment. The Hospital will use different coloured paper to identify patients who had not re-registered.
Patients told us that being given an estimated waiting time would be helpful to them. Research by Healthwatch England showed that patients feel negatively about the waiting time if they have not been given an estimate.
Work to install a sign displaying the estimated waiting time is now in the early stages. The triage nurse in the Emergency Department will routinely tell patients the expected waiting time.
91% of patients were positive about clinical staff.
Staff from the Urgent Care Centre had concerns about staffing capacity. There was difficulty recruiting Emergency Nurse Practitioners and therefore a reliance on agency/bank staff for this role.
The provider responded that they run bespoke University accredited training courses and plan to shortly advertise for a consolidation post.
The provider’s initial response did not fully address concerns in some cases, leading us to make six further recommendations:
- We asked the Hospital to work to reduce the time it takes to repair broken seating.
- We have asked the providers to ensure secure wheelchair storage in the Department to give staff consistent and reliable access to wheelchairs/mobility aids.
- Confusion around re-registering at the ED reception was not fully addressed. We asked the providers to consider better signage to direct patients to reception.
- We asked providers to make sure staff are routinely explaining the next steps to patients.
- The provider is planning a sign to inform patients of the estimated waiting times. Providers should consider combining this with a sign that flashes up the patient's name when called for assessment/treatment.
- Several ED patients were not aware of the call bells in the Department, we recommend that staff be reminded to alert patients to their presence.