King’s College Hospital emergency department still ‘requires improvement’

Katherine Johnston (19 February, 2020)

Inspectors report on their latest visit


King’s College Hospital’s emergency department still “requires improvement” according to the latest inspection report published this week.

The Care Quality Commission’s (CQC) inspectors previously rated the entire trust as requiring improvement in 2019 over care concerns.  During follow-up visits to Denmark Hill’s A&E last November, inspectors found key waiting time targets were not being met, and that mandatory training still had not been completed by all staff.  Some subjects had completion rates as low as 22 per cent.

Single use equipment was not being rotated properly to make sure all items were in date, with “a significant number of items [found] past their use by date.”  And the long-term lack of suitable premises for mental health assessments for children had still not been resolved.

At the time of the visits, there was still no dedicated paediatric mental health assessment room in the paediatric emergency department “fit for purpose”. Instead, a cubicle was being used.

The report explained: “Although we recognised the work the service had done to mitigate risk and the planned building work which was due to commence shortly after the inspection, despite this, at the time of the inspection the risks remained.”

Also highlighted was the “lack of consideration given to ligature points and other environmental factors that could allow paediatric patients with suicidal tendencies to come to harm in the paediatric emergency department. This had not changed from the last time we inspected.”

At the last inspection it was discovered that staff were not following best practice when prescribing, giving, recording and storing medicines.  This is an area that had seen significant improvement.

One of the biggest difficulties for the trust is meeting its key time targets. Patients should be either admitted, transferred, or discharged within four hours of arriving at A&E in at least 95 per cent of cases. This has been a long-term issue for King’s.

King’s College Hospital’s emergency department is a major trauma centre for the entire south-east, and also a stroke and cardiac arrhythmia and cardiac arrest centre with growing pressures.

The latest data shows that for the end of the second quarter of 2019, this target was met 63.2 per cent of the time. By November 2019, the same figure for quarter three was at 63.9 per cent.

The CQC has told the NHS Trust that its staff must complete their mandatory training, push ahead with the mental health specialist assessment room in its paediatric department, ensure all equipment is in date and meet its four-hour waiting time targets.

Also inspected was the trust’s Bromley A&E, at Princess Royal University Hospital, which fared worse than Denmark Hill due to “weak” governance, a culture of “learned helplessness”, and “apathy towards patients and visitors” reported amongst some staff, and “low morale”.

Responding to the report, a spokesperson for the trust said: “We accept that CQC found that there is still much to do to improve our emergency departments.

“Both departments continue to be busy, however we cannot allow this to distract us from the improvements that need to be made in terms of patient care and support for our staff.”

Dr Nigel Acheson, deputy chief inspector of hospitals, described the outcome as “disappointing” but also commented: “There were some moves towards improving care and some more in the pipeline.

“CQC will be keeping a watchful eye on the emergency departments at both King’s and the PRUH, to ensure future care gets better.”


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