Improvements at Weston A&E in the last 12 months

One year after the Accident & Emergency (A&E) department at Weston General Hospital temporarily closed overnight, the department is providing a safer service to patients, although staffing levels are not at a level that enables the department to safely reopen overnight.

 

On 4 July 2017, the Trust Board of Weston Area Health NHS Trust (WAHT) took the difficult decision to temporarily close the department from 10pm until 8am until the local NHS could be confident that safe and sustainable staffing levels were in place throughout the night. The Trust has had difficulty for a number of years in recruiting the right number of doctors needed to run an A&E department 24 hours a day, seven days a week, and in particular, to have sufficient doctors to staff a rota with overnight duties to make sure we can run the service safely at night.

 

Chief executive of WAHT, James Rimmer, said: “This was a very difficult decision and one that we did not take lightly. During the last year we have continued to review the care we are providing in our A&E and we have made progress to recruit doctors into the department. I thank our staff, our colleagues in NHS partner organisations and most of all our patients and families who have worked with us to manage this change safely.” 

 

WAHT medical director, Dr Peter Collins, said: “We are pleased we have made a number of safety improvements to the department. These include introducing ‘safety nursing sisters’ within the department, whose role is to ensure the safety of the department by completing hourly safety rounds – checking sepsis screening, medication checks, workforce numbers and equipment - and we are also using the ‘safety checklist’ that ensures patients’ assessments and tests happen in a timely way in order to improve patient safety.

 

“We have also changed how we work so that local patients with some conditions can be admitted directly to a ward for treatment in Weston General Hospital at night when the A&E is closed and no longer need to be taken to Bristol or Taunton for treatment. This includes patients being referred directly by their GP for certain conditions, and fractured neck of femur direct access.”

 

The department is providing a safer service to patients

The A&E department’s performance against the national target to see and treat, admit or discharge patients within four hours has improved in the last year. In 2017-18, it was 85%. This financial year it is averaging over 90%.

 

Alongside the introduction of the ‘safety nursing sisters’, the department introduced the safety checklist. The checklist, that was developed and tested at University Hospitals Bristol NHS Foundation Trust with support from the West of England Academic Health Science Network, ensures that assessments and tests happen in a timely way in order to improve patient satisfaction and reduce risks. The checklist was recommended to A&E departments throughout England as a way of improving clinical processes and improving safety within the department.

 

Improving the physical layout of A&E

In August 2017, Weston Area Health NHS Trust was awarded £842,000 from NHS England (NHSE) to introduce primary care streaming – this money has been allocated for building work to help redesign the front door to fully enable primary care streaming to have the maximum impact. Primary care streaming is a patient pathway within urgent care whereby patients who self-present to the A&E department and have needs that can be best met by a GP/primary care service, are seen accordingly and thus enable the A&E staff to care for those patients who need their acute assessment and treatment skills. We also released office space back into clinical space creating in total six ‘see and treat’ bays.

 

Implementing direct admissions pathways

The Trust has changed how it works so that some patients can be admitted directly to Weston General Hospital when the A&E department is closed. Some local patients can be admitted directly to a ward for treatment when A&E is closed and no longer need to be taken to Bristol or Taunton. This includes patients being referred directly by their GP for certain medical conditions, and direct access for patients with suspected fractured neck of femur.

 

Progress on recruitment of doctors

The Trust has made progress to recruit doctors into the department in the past year. There are currently 6.68 out of 9 middle grade posts filled and 4.5 substantive consultant posts out of 8 filled.

 

While this is not yet at a level that enables us to reopen the department overnight, we have made good progress on recruitment in an area of medicine where there is a national shortage of staff. This stable group of staff has been one of the key drivers that has enabled us to improve safety and quality within our A&E.

 

During the temporary overnight closure, the local NHS is managing well and patients continue to receive safe care either the Bristol Royal Infirmary, Southmead Hospital in Bristol or Musgrove Park Hospital in Taunton.

 

Conclusion

WAHT chief executive, James Rimmer, added: “It is challenging to recruit staff in areas where there are national shortages. We have made good progress to recruit doctors, although we are not yet at a level where it would be safe to reopen overnight. We also face a shortage of registered nurses within the department. My commitment to staff, patients, their families and the public, is to continue to make improvements to the quality of care we provide in our A&E department.

 

“Finally, none of these changes would have been possible without the hard work and commitment of staff colleagues who have worked tirelessly to improve our services for patients. My thanks go to them for their ongoing dedication despite what has often been a challenging and uncertain period.”