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Patient left on urine-soaked sheets in overcrowded ED

Serious concerns were raised over patient safety when an inspection of an emergency department found overcrowding and understaffing was putting patients at risk
A patient on a trolley waiting to be seen at an emergency department: one emergency department in NHS Lothian put patients at risk because of overcrowding and understaffing

Serious concerns were raised over patient safety when an inspection of an emergency department found overcrowding and understaffing was putting patients at risk

A patient on a trolley waiting to be seen at an emergency department: one emergency department in NHS Lothian put patients at risk because of overcrowding and understaffing
Picture: Charles Milligan

Dozens of patients in an emergency department (ED) were being cared for next to nursing stations and on trolleys in corridors with one patient lying on ‘urine-soaked sheets’, a new report has found.

Serious concerns over patient safety raised after unannounced inspections

Following three days of unannounced visits to the Royal Infirmary of Edinburgh in February, inspectors from Healthcare Improvement Scotland (HIS) escalated ‘serious concerns’ over patient safety to NHS Lothian, which manages the hospital.

The HIS report said staff raised concerns about the care and dignity of patients with inspectors. One patient was found in a corridor area in the ED on ‘urine-soaked sheets’, while another was left on a blood-stained pillow ‘for several hours’ before it was changed because of intense pressures on staff, the report added.

Overcrowding in the ED was also highlighted with inspectors reporting that at times there was no space for staff ‘to move in any direction’ because of high numbers of patients being looked after in corridors. At one point, there were 110 patients in the ED which has a total of 35 cubicles and four resuscitation bays.

High levels of vacancies put emergency department under ‘relentless pressure’

The report added: ‘Evidence provided by NHS Lothian demonstrated that within the week prior to the first onsite inspection, the department was, at times, operating at over 300% capacity.’ The health board told the Nursing Standard they were under ‘relentless pressure.’

Workforce data examined by inspectors showed ‘high levels’ of vacancies for registered nurses at the hospital. A benchmarking exercise using RCN workforce standards showed there were a higher number of staff nurses and fewer staff in leadership roles, which was ‘below the recommended skill mix’.

However, inspectors did find evidence of teamwork and person-centred care in inpatient wards, and nursing teams reported feeling supported by managers.

‘There has been some progress in rebalancing the skill mix and reducing reliance on junior staff, with additional staff recruitment into senior posts,’ the report added.

Improvement plan includes more senior staff working in the department

NHS Lothian said it recognised there was ‘much work to be done’. Nurse director Alison Macdonald said: ‘There has been unprecedented pressure on our healthcare systems, which has been relentless in recent times, as the inspection team was able to experience first-hand.’

The health board has put an improvement action plan in place, which includes further training and support for staff and more senior staff in the ED to support improvements.


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