University Hospital

Ratings - Urgent and emergency services

• Overall

  Requires improvement

• Safe

  Requires improvement

• Effective

  Good

• Caring

  Requires improvement

• Responsive

  Requires improvement

• Well-led

  Good

Our view of the service

The urgent and emergency care directorate at University Hospital compromises of an adult emergency department (AE), a children’s emergency department, a minor injuries unit and urgent treatment centre, a surgical assessment unit, a medical same-day emergency care service, a frailty same-day emergency care service, and a gynaecology emergency unit.

Our inspection focused specifically on the adult’s emergency department and the children’s emergency department.

The adult emergency service at Coventry is a level one major trauma centre. Trauma patients could arrive by road or air ambulance. The service is one of the busiest major trauma centres in the UK.

Within the adult emergency department there was a resuscitation area for adults and 2 separate paediatric resuscitation rooms, a rapid assessment and treatment area for assessment of people arriving by ambulance. There was a majors area for those who were the most unwell, a patient ‘fit to sit’ area, and a waiting room. Within the children’s emergency department were high dependency rooms, a majors area, and a waiting room.

Majors is an area for patients with serious and life-threatening conditions. People with non-life-threatening conditions who were in need or urgent treatment were streamed by a senior nurse to the minor injuries unit or the urgent treatment centre. Fit to sit was a seating area with eight chairs designed to be used at times of overcapacity to prevent patients being held in areas considered inappropriate. The patients in this area were assessed as having lower clinical acuity than other patients within the majors area.

We visited the adult’s emergency department and the children’s emergency department twice. At the first visit which lasted 2 days, a team of 2 inspectors and 2 specialist advisors spoke with 49 members of staff (including managers, doctors, nurses, healthcare assistants, healthcare professionals, receptionists, and administrative staff). We spoke with 24 patients, 3 relatives, we reviewed 19 whole or partial sets of patient notes, and we attended 6 meetings. The second visit took place 4 weeks later and lasted 1 day. The inspection team included a deputy director of operations, a senior specialist, and an inspector. At this visit we spoke with some of the same staff we had previously spoken with, we reviewed 6 partial sets of notes and attended 1 meeting.

We carried out this assessment following information of concern around waiting times and poor performance indicators. We inspected 30 quality statements across the safe, effective, caring, responsive and well-led key questions.

The demand on the service was so high at times and the capacity exceptionally constrained as a result that despite best efforts, staff were not always able to provide satisfactory care, especially for those patients waiting for treatment in the waiting rooms. However, patients who had been admitted to the majors department received good care and treatment that followed evidence-based practice, although because of long waits for treatment outcomes were not always positive. Staff were kind, caring and compassionate but could not consistently provide the best person-centred care or maintain patients’ privacy and dignity due to the demands placed on them. The department and staff were well-led by strong leaders who embodied the cultures and values of their workforce. However, due to constraints across the whole health and care system, leaders could not always make improvements to the service to provide the best safe and effective care that was responsive and met people’s needs.

We found 5 breaches of the legal regulations in relation to safe care and treatment, staffing, premises and equipment, dignity and respect, and person-centred care.

People's experience of this service

The service was under significant pressure from demand and the ability to move patients for onwards care, so the department was often overwhelmed with patients. The majority of the risk was in the waiting area where unwell patients were having to wait in chairs for long periods of time, and not always getting the timely care they needed. Some patients were having to stand, and others were not able to have their family or friends with them as there was no room for them to wait. People told us they were anxious about the crowding, the delays, and not knowing when they would be seen. People told us they had to ask for help at times for themselves and others.

However, patients and the family members and carers with them told us staff treated them with warmth and kindness. They said they understood how exceptionally busy the department was and the subsequent reasons they experienced delays with treatment. 

Some people said they felt they were not always able to raise concerns about the length of time they had been waiting for treatment or waiting to be transferred to a ward. Most people said communication about waiting times was confusing as the electronic system used to show average waiting times and the length of time to be seen by a doctor was misleading. For example, a person told us the board said the wait to see a doctor was 7 hours but the average wait to see a doctor was 1 hour.