Fourth Walk-Thru: QA Hospital Emergency Department

Healthwatch Portsmouth undertook a “walk-through” of Queen Alexandra (QA) Hospital’s Emergency Department (ED) on 27 August 2021, focusing on patient experience, processes, and recommendations for improvement. 

It found that signage at the ED entrance was initially unclear, although improvements were planned and later implemented. On arrival, patients are directed through a triage system that prioritises life-threatening conditions and encourages those with less urgent needs to use NHS 111, either on personal devices or via iPads provided on site. 

The report highlights confusion caused by NHS 111 describing arrival “slots” as appointments, which can lead to unrealistic expectations about waiting times. Healthwatch recommends clearer communication to manage patient expectations and reflect that patients are seen based on clinical priority rather than arrival time.

It also identifies inefficiencies caused by a lack of integration between IT systems used by hospitals, GP practices, and NHS 111, which can duplicate triage processes and slow patient flow. Patients without referral letters are often required to repeat assessments through 111, adding to delays. 

A key issue raised is the number of patients—particularly younger adults—attending ED with minor injuries that could be treated elsewhere. The report recommends better public communication about appropriate services and clearer guidance on what constitutes a major versus minor condition.

The walkthrough notes pressures on urgent care pathways, especially at St Mary’s Urgent Treatment Centre (UTC), where long queues and poor coordination with ED and NHS 111 can result in patients being redirected multiple times. This creates frustrating and inefficient “circular journeys,” and the report suggests improved communication and real-time capacity sharing between services. 

Within the ED itself, the report finds that triage generally happens quickly (within around 15 minutes in the navigation area), and patients are seen according to clinical need. However, accessibility issues were observed, such as reception desks not always being suitable for wheelchair users and unclear hearing loop signage, although these were later addressed. 

The ED includes several functional areas such as majors, ambulatory care, ambulance bays, and a mental health observation room, but demand is very high, leading to frequent ambulance queuing when capacity is full. 

The report also describes the Acute Medical Unit (AMU), which supports admissions and aims to avoid unnecessary hospital stays through same-day emergency care pathways. Improvements in discharge processes, such as criteria-led discharge and better coordination with the Discharge Lounge, are highlighted as helping patient flow. 

The Discharge Lounge is identified as a positive development, enabling patients to leave wards sooner while waiting for medication or transport, thereby freeing up beds. It provides clinical oversight, transport coordination, and patient support, although rising demand is putting pressure on capacity. 

Overall, the report concludes that while many aspects of the ED and patient flow are working well—such as triage processes, patient support services, and discharge improvements—significant challenges remain. These include high demand, confusion about access routes, poor system integration, and weak coordination between urgent care services, all of which affect patient experience and efficiency.