Crosshouse: Patients 'critically ill' waiting outside A&E

An unannounced follow-up visit in July found that wards and departments were "calm, organised and well led", with patients "complimentary about hospital staff and the care they provided".

However, inspectors from Healthcare Improvement Scotland (HIS) noted that the health board "like much of NHS Scotland" was experiencing "significant pressures including increased hospital capacity, reduced staff availability and increased waiting times in the emergency department" at the time of their visit.

READ MORE: Patients 'in recliner seats for days' due to bed shortage, find inspectors

Crosshouse hospital was "operating at a capacity of over 100%" with a seventh bed added into six-bedded bays. However, not all patients in these additional beds had call bells, curtains or privacy screens, or a designated oxygen port.

The report added: "On the second day of inspection University Hospital Crosshouse was under extreme pressure with increased capacity.

"This was due to a high number of attendances to both the emergency department and combined assessment unit in the previous 24 hours.

"This resulted in delays within the emergency department with 11 patients remaining in the department for longer than 12 hours, with the longest wait for transfer to an inpatient bed being 26 hours.

"Both the emergency department and combined assessment units were over 100% capacity with five patients being cared for on trolleys in the corridor in the emergency department and two in the combined assessment unit.

"Staff we spoke with described the continual assessment and reassessment of patients clinical needs to ensure those who are most unwell are prioritised."

The number of patients spending over eight and over 12 hours in A&E departments in Ayrshire has increased substantially over the past two years, as it has across Scotland (Image: PHS)

READ MORE: Probe into patient deaths in ambulances outside A&E

As part of its inspection in July, HIS requested that NHS Ayrshire and Arran provide any evidence of any incidents or adverse events in relation to patient safety within the emergency departments at Crosshouse and University Hospital Ayr.

They identified "several incident reports where patients had become critically unwell while waiting outside the hospital in ambulances due to a lack of available space within the emergency department".

The report added: "We discussed this with senior hospital managers who were aware of these incidents and explained the actions that had been taken in response.

"This included the nurse in charge of the emergency department reviewing patients who remain in ambulances for long periods...we also discussed this with ambulance crews who were waiting with these patients and we were advised that regular checks from the nursing staff were now common practice."

All patients are triaged on arrival and inspectors were told that those "assessed as a priority are brought into the department".

The report said senior managers had also "highlighted the systems in place to ensure lessons are learned from reported adverse events".

HIS previously raised the alarm over safety at Crosshouse following an inspection in May 2022 when they discovered that some patients had spent up to 28 hours on trolleys in corridors waiting for treatment in the hospital's combined assessment unit (CAU), with others spending three days on recliner chairs before being admitted - increasing the risk of pressure sores.

Concerns were also raised over patients being cared for in mixed sex bays, overcrowding, staff shortages, and care needs such as personal hygiene and nutrition not always being met for older adults waiting to receive treatment.

READ MORE: Overcrowded A&E departments playing 'Russian roulette' with patients' lives

At the time of the May inspection, the fire alarm also sounded but staff were unable to move patients "because they did not know how".

The HIS report for July said knowledge of fire safety procedures had "significantly improved" with 98% of staff having received fire safety and awareness training and quarterly ‘walk through, talk through’ programmes in ward areas evaluating evacuation routes and emergency procedures.

Inspectors noted that patients cared for on trolleys "were not causing an obstruction of the corridors".

Inspectors said staff were "focused on the provision of safe and compassionate care" and praised the hospital's "open and transparent culture with a good focus on patient care and safety".

Nine of the 13 requirements issued following the May 2022 inspection have been met, with "progress made" on the remaining four.

These included ensuring that personal protective equipment (PPE) is used in line with current guidance and that staff are cleaning their hands "at appropriate moments".

Inspectors have issued eight new "requirements" for improvement.

These include the safe storage and administration of medicines; ensuring that all patient trolley mattresses are clean and ready for use and that contaminated mattresses are effectively identified; that all hazardous cleaning products are securely stored; that all clinical waste, including full sharps boxes, are stored in a safe locked area; and that an up to date locked door policy and risk assessment is in place.

The HIS report added: "Through completion of both this follow-up inspection and the focused inspection at University Hospital Ayr we are assured progress has been made in NHS Ayrshire & Arran to satisfy the serious patient safety concerns raised under level one of our formal escalation process following the May 2022 inspection."

Jennifer Wilson, Nurse Director for University Hospitals Ayr and Crosshouse, said NHS Ayrshire and Arran is "committed to the provision of high standards to ensure our patients receive safe and dignified care at all times".

She added: "The report highlighted an open and supportive culture, with our teams focused on providing safe and compassionate care to our patients.

"We acknowledge that there are areas where we need to make further improvements, and these have been addressed in our action plan."