Queen’s Hospital, Romford Emergency Department (A&E) Streaming and Urgent Treatment Centre provided by PELC

Healthwatch Havering carried out an announced Enter & View visit in December 2018, as a result of which a number of recommendations were made for improvement in the arrival and waiting arrangements.

Given the importance of the arrangements for initially assessing patients for A&E services, Healthwatch decided to carry out an unannounced visit as a follow-up to the December visit and the later review in March. This report sets out the findings of the follow-up visit.

Findings

When the team arrived for the visit, there were 52 people waiting in the reception area, 14 of whom were waiting in the queue.

Children go through the same streaming service, but are signposted to the children’s waiting area (which appeared quite shabby and lacked toys, television or any means of entertainment for those who are waiting).

People waiting in this room included patients waiting to be streamed, streamed patients awaiting assessment, those waiting to be called to other departments and those part-way through their treatment awaiting results, or to speak to a doctor. During the visit, the team witnessed several people who had been assessed but were confused about where to go next.

If there were more than 6 people in the queue, an escalation process took place, which the team observed happening.

 At the time of the visit, over 70% of the patients who walked in were seen within the UTC, an improvement from 45% being dealt with there in July 2018. This reduced the number of patients going to the main A&E department, relieving the pressure there, whilst ensuring patients were treated in the right place at the right time.

The team specifically compared what they observed during this visit with the action plan that had been proffered following the previous visit. They considered that the signage was still in need of improvement, that the “tannoy” system was not in use and that staff were not clear whether the loop system (for hearing aid users) was working.

Recommendations

1. There should be a more child-friendly process for registering children by moving children’s registration elsewhere and then sent directly to the children’s A&E area.
2. Signage within the waiting area still requires updating. It is recommended that, when the new ticketing system is introduced, all existing signage be replaced.
3. All possible efforts should be made to improve conditions in the waiting area and, in particular, although it is understandable that patients should want to be accompanied by friends or family, they should be encouraged to have only the absolute minimum of companions waiting with them.
4. A member of staff should be tasked to monitor in an obvious way as a means of reassuring patients and ease any anxieties they may experience.