The care watchdog has said patients visiting King’s College Hospital’s A&E are ‘being put at risk of catching COVID-19’ but highlighted its committed staff and ‘dignified’ care of patients.
Inspectors from the Care Quality Commission (CQC) carried out the focused inspection at the Denmark Hill hospital’s emergency department in July this year to check up on the service after a visit in July 2019 raised concerns about patient care, staff culture, governance and leadership.
They also assessed how the department was coping with the added challenges posed by the pandemic. The hospital is one of England’s busiest – with 122,000 patients attending in the last twelve months.
The trust is rated overall as ‘requires improvement’ by the watchdog, and due to its financial circumstances, rated ‘inadequate’ for its use of resources specifically. King’s College Hospital is also rated ‘requires improvement’.
The CQC has said the age of the building and its layout has made it difficult for A&E to adequately socially distance patients.
During the latest inspection they discovered that there was no clear signage to indicate which cubicles may have a patient with confirmed or suspected COVID-19 inside – “putting people at risk of catching the virus”. Poor hand hygiene from some medical staff was also noted.
The regulator also reported that ‘several areas’ of A&E were ‘cluttered and untidy’ with boxes of equipment ‘left lying around’ posing hazards for patients and staff.
Another key safety concern was found in a room used for checking children’s mental health, where two potential ligature points were identified on the internal door handles, presenting a risk of choking.
Inspectors said at one point the ambulance triage station was unmanned for fifteen minutes with an unlocked computer screen displaying patient details in a public area.
More positively, inspectors reported that staff were working well with other agencies to recognise and protect patients from abuse; treated patients with ‘compassion and kindness’ as well as taking into account their individual needs, and ‘respected their privacy’.
The department had enough nursing and support staff with the right qualifications, training and experience, and patient records were kept updated with “nationally recognised early warning scores, sepsis reviews and other observations and assessments properly completed”.
Nigel Acheson, CQC’s deputy chief inspector of hospitals, said: “During the recent inspection of King’s College Hospital, we found a workforce that was committed to providing safe, dignified care to its patients.
“However, the age and layout of the building sometimes made it difficult for staff in the emergency department to provide the best possible care for people, as it created issues with access to, and flow within, the emergency department.
“For example, it was difficult to maintain social distancing in the waiting area of the walk-in reception, which put people at risk of catching infections such as COVID-19.
“Although the trust had undertaken work to alleviate this situation where possible, there were limits to the action they were able to take due to the age of the building.
“In addition, some patients from outside the area were being treated at King’s, due to the specialist services the hospital provides.
“Following their treatment, they were sometimes unable to be transferred back to their original hospital due to a lack of beds.
“This meant that other patients in the emergency department who needed to be moved elsewhere in the hospital had to be held in the emergency department for longer than necessary until a bed became free for them.
“To alleviate this problem when it occurs, other regional healthcare systems need to work to support King’s to provide the necessary bed space in their own hospitals to remove these blockages.
“We have reported our findings to the trust leadership, which knows what needs to be done to bring about further improvements. We will continue to monitor the service to ensure that the improvements are made and fully embedded.”
Professor Clive Kay, Chief Executive, King’s College Hospital NHS Foundation Trust, said: “Firstly, I am proud that staff in the emergency department at King’s were found to treat patients with compassion and kindness – two fundamental elements of good care.
“A number of changes were made in [the department] to improve standards following the CQC’s inspection in 2019.
“These have been reflected in the CQC’s most recent report, but we know there is a lot more work to do.
“Providing safe and effective care for patients is our number one priority.
“We are taking steps to address issues raised in the CQC’s report, and we are committed to delivering further improvements as quickly as possible.”