Enter and view: West Middlesex University Hospital Urgent and Emergency care

Healthwatch Richmond undertook an Enter and View visit to West Middlesex University Hospital Urgent and Emergency care on 16 and 19 August 2019. They spoke to 78 patients and 19 staff.

Findings

• Overall patient experience was positive. 63% of patients were positive about the streaming process. Almost all patients were streamed within 20 minutes.
• There were issues with the streaming and registering systems, including for patients who had a letter from their GP referring them to the Emergency Department.   The use of a streaming desk meant that patients’ privacy could be compromised and there was nowhere for them to sit.
• Many chairs in the waiting room were broken at the time of the visit.
• There was a 50-50 split in patients contacting a health service before attending the Urgent Care Centre (UCC)
• Most patients were positive in their feedback about UCC clinical staff.
• Staff felt there was a good system for monitoring patients
• Staff feedback indicated concerns about staffing capacity with difficulty recruiting, and reliance on agency/bank staff for the Emergency Nurse Practitioner role being highlighted
• Most patients attending the Emergency Care Centre (ECC) (~80%) had contacted a service before attending (most commonly their GP) suggesting patients preferred to get medical advice before using ED services.
• most patients provided positive feedback about triaging. Staff felt able to triage patients effectively but did suggest that an ED technician should, during busy periods, be assigned directly to triage
• The environment of the Department was well proportioned and functional, and great thought had been taken with the refurbishment of mental health rooms.
• The patient feedback was positive and indicated their privacy and dignity had been respected.
• Patients weren’t always aware of where they can get food/drink during their time in the Department
• Patients felt they were given good information on what was happening and what will happen next.
• Most patients gave positive feedback about the ED clinical staff and felt they had good communication with them.
• Patients highlighted they were not aware of call bells
• It was clear that there is a challenge in supporting patients who attend the ED with mental health concerns, and the Hospital has acted to try to meet these challenges. These patients face long waits in the Department and their care involves the coordination with inpatient mental health providers.
• A small number of staff identified a possible issue around having adequate staffing capacity to meet patients’ needs in the context of the increasing demand on the ED. But there was good support from senior staff and staff had confidence in raising incidents, including safeguarding concerns.

Recommendations

There were recommendations on the following issues:

 

• Better signage to a clearly signposted ED reception point
• Improving information about waiting times
• Dealing swiftly with broken chairs
• Better monitoring of patients
• Staffing shortages
• Call bells