CQC tells UHBW Bristol Campus to make improvements

The Care Quality Commission (CQC) has told Bristol Royal Infirmary, 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 Bristol Royal Infirmary 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.

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."

Inspectors found:

• There were not enough trained fire wardens. This was a breach of the regulation for safe care and treatment because of the potential impact on people's safety in the event of a fire
• 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
• Inspectors found that support from mental health liaison staff could be improved out of hours and at weekends.

However:

• 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.

The report will be published on CQC's website in the coming days.