Stretched A&E staff ‘rarely saw exec team’, review finds

An independent review described York Hospital as “reluctant” to trigger internal escalation processes, and suggested it should be quicker to admit extra patients to inpatient wards during busy periods.

The review, obtained by HSJ  through a freedom of information request, was conducted in late December by Matthew Cooke, a former national clinical director for emergency care.

Professor Cooke, who said that during his two-day visit to the department he witnessed a 60-hour delay for a patient to be admitted, wrote: “I was surprised not to see any senior managers or executives in the ED, despite such long delays. ED staff reported they rarely saw the executive team.”

York and Scarborough Teaching Hospitals said it had commissioned the review proactively and the findings would now be considered as part of improvement plans.

Although there are questions over the accuracy of the data, statistics for February suggest the trust was in the top 20 poorest performers for long waits in accident and emergency, with nearly one in five emergency admissions waiting for 12 hours or more after a decision to admit.

Professor Cooke also warned of uncertainty over escalation processes, including for reducing pressure in the emergency department by “boarding” patients on wards beyond normal capacity.

He said: “On the second morning, there were multiple patients on oxygen in ordinary seats in majors waiting room, cared for by a single nurse. I find it difficult to understand how this is safer than boarding one extra patient on several wards.”

“Staff perceived that the organisation was reluctant to move to higher escalation levels and I sensed this meant staff no longer pushed for such actions.”

The assessment concludes the “exit block” facing the emergency department was the “single factor creating greatest risk”.

Professor Cooke told HSJ the department’s staff were working “incredibly hard in extremely difficult circumstances” to keep patients safe and informed.

The review comes as the Care Quality Commission is set to publish inspection reports covering the trust’s emergency care, maternity services and medical wards, as well as its leadership.

Recent board meeting minutes refer to “unsafe/ineffective care” at York A&E, warn of “defensive behaviour”, and claim staff were “completely underperforming when CQC there”.

However, one committee member said the emergency department staff felt they were taking the risk not the wards, adding: “There are not always the appropriate staffing levels on the wards to manage transfers from ED.”

York and Scarborough Teaching Hospitals said in a statement: “As part of the improvements to our estate and ways of working, we proactively invited Prof Matthew Cooke into the organisation to share his professional insight and support us in developing new models of acute and emergency care.

“We welcome the content of his report, and the recommendations have been considered in the context of our broader organisational and system-wide improvement plans for urgent and emergency care.”