Critical incident declared by major acute trust

One patient spent a total of 16 hours at Leicester Royal Infirmary’s emergency department, a source with specific knowledge of the department yesterday told HSJ. 

University Hospitals of Leicester Trust said high attendances coupled with increased admissions over the bank holiday weekend continued into Wednesday, causing a back-up in A&E. 

Chief operating officer Richard Mitchell said 12 patients were waiting in A&E for a bed at the height of the critical incident although no-one waited longer than eight hours following the decision to admit.

He said: “No patients were waiting in excess of eight hours between the decision to admit and getting a bed.”

The trust, which serves a population of 1.3m, has seen soaring attendances since opening its new A&E department last month, including a record of 805 attendances in a single day.

The source told HSJ the internal incident was due to a lack of flow of patients out of the ED.

They said there were more than 60 patients waiting in the A&E yesterday morning with 17 waiting for beds, including seven spending more than a total of 12 hours in the department.

Among these patients, one had spent more than 16 hours in the department, another had been there for more than 15 hours with two approaching 14 hours and several patients at or above 12 hours.

They added around five more patients had been in the department between 10 and 12 hours.

Mr Mitchell said he could not comment on how long patients had spent in total in the department because he had not seen the information provided to HSJ.

However, he said the 60-plus patients were spread across different areas of its emergency services including eye casualty, GP streaming, assessment zones, urgent care centre, majors, minors and resuscitation.

The critical incident, the highest level of internal escalation, was declared at 8am yesterday and was in place for 10 hours with staff taken off non-clinical duties to assist A&E staff and ensure patient safety.

“Going into a critical incident was very sensible,” Mr Mitchell said. “It enabled us to make sure we could deploy as much medical and nursing support into emergency pathways, particularly at Leicester Royal Infirmary and at the Glenfield site.”

The incident was stepped down at 6pm after the situation improved.

Mr Mitchell said the trust’s bed occupancy at Leicester Royal Infirmary was running at 97 per cent last night but had fallen to 92 per cent by 1pm today. This is higher than the 85 per cent level suggested by the National Audit Office.

He added that while the emergency department remained busy, at 2.20pm today, the longest a patient had been waiting in total in the emergency department was six hours.

The new emergency floor was opened last month. It doubled cubicles from 16 to 32 and created a new rapid ambulance access and replaced the old A&E, which was designed to see 140,000 annual attendances but saw 240,000 last year.

When it opened last month, trust chief executive John Alder said the extra cubicles would help address capacity and flow problems and improve the trust’s four-hour waiting time target performance, which was then at around 85 per cent.

However, he said the trust would still have a capacity deficit of 105 beds.

Mr Mitchell said: “John Adler was very clear that opening the department, while very important, was only part of the solution.

“The next steps are making sure we increase medical capacity and bed capacity across the three sites and we’re about 40 per cent of the way through doing that.”