Charge nurse’s workload left emergency department ‘poorly managed’

Nurse in charge had ‘too many other tasks’ to take control of patient flow, CQC finds  

Nurse in charge had ‘too many other tasks’ to take control of patient flow, CQC finds 

The emergency department at Queen Alexandra Hospital, Portsmouth. Picture: Alamy

A nurse overseeing an emergency department had too many tasks, which distracted them from managing patient flow, inspectors have found.

A Care Quality Commission (CQC) inspection of the emergency department (ED) at Queen Alexandra Hospital in Portsmouth in February found that patient flow was being ‘poorly managed’.

Inspectors said part of the problem was that the designated nurse in charge had too many other tasks distracting them from undertaking a command and control role.

Poor flow

They observed that the nurse was undertaking a range of tasks, including moving trolleys and patients. 

'This distracted them from managing the ED and likely affected the poor flow across the emergency pathway,' the CQC said.

The ED, which has been rated as 'requiring improvement' since 2017, was the subject of a focused inspection in February as part of a programme to assess safety during the winter period. This latest inspection did not give a rating.

Lack of capacity

The February inspection found that, as a result of ‘poor departmental flow’, staff reported patients were often held on ambulances outside the ED because of a lack of capacity to receive them.

Inspectors found the waiting area did not have enough seats to accommodate patients and at peak times patients and visitors were standing for extended periods as delays were caused by the congestion.

They also found that at times the privacy and dignity of patients was not protected. They provided examples to the trust of occasions when nursing staff had failed to cover up patients, instead opting to half close cubicle curtains.

Appetite for change

However, the CQC reported an ‘appetite among staff to improve the quality of care provided in the department’.

'Health professionals reported good multi-team working, with positive working relationships existing between doctors and nurses,' the CQC added.

Portsmouth Hospitals NHS Trust chief executive Mark Cubbon said the hospital was under ‘considerable pressure’ at the time of the inspection, with more than 1,300 extra patients in the ED in February compared with the same month last year.

Operational pressures

'We fully recognise that it is not acceptable for any patient to wait longer than they should and no matter what the operational pressures, our focus on patient care and experience must remain paramount.'

The trust recently announced £58 million in funding to transform urgent care services, including building a new ED.

Further information

Read the CQC report

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