NHS Forth Valley: Concerns over busy A&E, long waits and use of extra beds

On the second day of their onsite inspection by Healthcare Improvement Scotland, the emergency department was operating at 193.3 per cent capacity with 15 patients waiting over 12 hours for admission to an appropriate care are.

The national target for accident and emergency waiting times means that 95 per cent of patients should wait no longer than four hours from arrival at the emergency department before admission, discharge or transfer for other treatment.

Across NHS Scotland for the week ending January 28 when the inspectors were in the hospital, 62.7 per cent of patients were seen within the four hour target with 38.1 per cent of patients seen within the four hour target at FVRH.

Latest figures issued this week show that of the 1161 patients who visited in a seven-day period, only 45 per cent were seen with the four hour window, with 638 people waiting over four hours, 243 over eight hours and 132 people waiting over 12 hours.

However, these figures are a slight improvement from previous weeks.

Despite the high number of patients and long waits noted in January, in their report inspectors observed “a significant improvement in the emergency department, acute assessment and clinical assessment units, which were calm, organised and well led”.

Since their last visit in September 2022, three new senior charge nurse posts had been implemented in the emergency department to provide senior nurse leadership where able on each shift.

However, they did raise concerns that not enough A&E staff were fully trained in paediatric life support – with only 19 per cent trained. Hospital managers gave an assurance that training was taking place.

The inspectors added: “We spoke with two patients who had been in the emergency department for 24 hours who described the staff as kind and attentive.”

They also looked at what provision was made for patients to wait and for their care during the capacity issues. They heard that every patient who arrived should have their first experience of triage within 15 minutes of arrival.

On wards in the hospital the inspectors noted that contingency beds were still being used, with a fifth patient in four-bedded room and the use of nonstandard bed spaces such as treatment rooms.

Inspectors noted that while they observed staff providing compassionate care with staff treating patients with dignity and respect, some patients expressed concern regarding the impact of additional beds on privacy and dignity. This point was reiterated by staff and patients’ relatives.

The inspectors report stated: “We acknowledge there have been improvements made in the emergency department, acute assessment unit and clinical admission unit regarding patients experience of privacy and dignity. However, the use of additional non-standard bed spaces continues to have a negative impact on patient experience.”