It was one of a number of issues identified during an unannounced inspection of the hospital’s emergency department earlier this year
An inspection at a Welsh hospital’s accident and emergency department raised concerns about the “safety and condition of equipment” at the hospital. Healthcare Inspectorate Wales (HIW) has published its inspection report following an unannounced visit to the emergency department (ED) at Bronglais Hospital in Aberystwyth over three days in July.
The report identifies several areas which require improvement “to protect patient safety”, but praised the dedication and professionalism of staff working at the A&E department under “considerable pressure”. Hywel Dda University Health Board, which runs Bronglais Hospital, has produced an improvement plan detailing how it will improve the emergency department.
Other concerns raised during the inspection include a lack of paediatric nurses in the department, a lack of compliance with hand hygiene standards, as well as patients being cared for in corridors. For our free daily briefing on the biggest issues facing the nation sign up to the Wales Matters newsletter here
One of the issues raised by the inspection was about the safety and equipment at the department. HIW checked the paediatric emergency trolley, the “difficult airway” trolley, and emergency resuscitation equipment and found that there were gaps in the record of checks.
Both of the trolleys were not sealed, meaning that equipment could be removed which inspectors said could result “in the absence of essential equipment in the event of an emergency”.
There were also gaps in the medication storage fridge temperature records and there were no safety notices attached to the door of the room where oxygen cylinders were stored.
HIW said these issues were addressed through its immediate assurance process and the health board has committed to ongoing monitoring and improvement.
The inspection also found that patients were often cared for in non-clinical areas such as corridors, due to delays in discharging patients from other parts of the hospital, impacting privacy and dignity.
HIW recommended that the health board continues efforts to improve patient flow and reduce reliance on non-clinical spaces.
The report indicated that reception staff within the emergency department had not received “red flag training”, which is intended to help them identify patients with time-critical conditions, or those who require more urgent assessment and treatment. HIW said the health board must ensure staff receive that training.
Concerns were also raised about the paediatric area of the emergency department. Inspectors found that the area was used to accommodate adult patients and was not consistently staffed with paediatric-trained nurses, which goes against Royal College of Emergency Medicine guidance which states that there should always be two paediatric-trained nurses in this area.
Inspectors noted that consultant cover was also limited, particularly overnight and at weekends. HIW has urged the health board to progress recruitment and ensure safe and effective cover arrangements.
Despite these challenges, the report praised the dedication and professionalism of staff working under considerable pressure, noting that patients were consistently treated with dignity and respect.
Despite ongoing challenges with patient flow and patients being treated in non-clinical areas, staff maintained a compassionate approach and demonstrated strong teamwork across the department, the report reads.
HIW said: “Staff worked well together and were committed to providing high-quality care. Systems were in place for managing complaints and learning from incidents, and patients had opportunities to provide feedback.”
The health board has now produced an improvement plan with actions on how improvements will be made at the emergency department.
Alun Jones, chief executive of Healthcare Inspectorate Wales, said: “Staff at Bronglais Hospital’s emergency department are clearly dedicated to providing safe and compassionate care despite very difficult circumstances.
“Our inspection highlighted areas of good practice but also identified significant issues with patient flow – challenges that are present across many emergency departments in Wales. We will continue to engage with Hywel Dda University Health Board to ensure improvement and progress against our findings.”
