‘Acutely’ unwell patients stuck for days in minor injury unit due to bed shortages
Richard Youle, local democracy reporter
Old and sometimes “acutely” unwell patients were stuck in a minor injury unit for up to five days because there weren’t enough hospital beds for them, health inspectors found.
The patients were in so-called “surge” beds at the Prince Philip Hospital minor injury unit (MIU) in Llanelli , and this area of the unit didn’t have a toilet.
Minor injury units mainly deal with things like muscle and joint injuries, burns and scalds and minor head wounds.
Healthcare Inspectorate Wales (HIW) said it could not be assured the “surge” patients at Prince Philip Hospital’s MIU received timely care while awaiting a hospital bed or transfer to another acute health site. Staff tried to improve their comfort as they were on trolleys for extended periods, there was support from therapists and social workers and hot food was provided, but windows were lacking and the environment was noisy.
Some staff said the MIU, which operates 24 hours a day, felt more like an accident and emergency department staffed by nurses and general practitioners. Some patients, they added, were very unwell mentally.
“We are not A&E doctors but are expected to deal with A&E patients,” said one of the 38 staff who filled in a questionnaire. The HIW report said only half of the 38 respondents were satisfied with the quality of care and support they provided to patients. In relation to patient care, just a third of staff felt they were able to meet conflicting work demands – and considerably fewer thought there were enough staff to enable them to do their job properly.
The report said: “Overall, we found the issues identified applied inappropriate pressures to the functionality of the MIU as a minor injury service. The staff and unit were not fully supported or equipped in light of these pressures to safely and effectively manage all presentations and patients accommodated on the unit.”
It added: “HIW acknowledges the significant pressures on front door services and, at the time of the inspection, this service was under immense pressure from multiple sources.”
The inspectors were on site for two-and-a-half days in June, during which time there were six “surge” patients being looked after.
For the larger cohort of patients who arrived with minor injuries, care was timely and respectful, and they left well-informed about what to do next. HIW also found aspects of good nursing and medical management, and staff spoke positively about they support they gave one another.
Infection prevention and control compliance was deemed satisfactory, but staff said infectious patients were looked after in a side room because there were no designated isolation rooms.
HIW identified improvements and immediate concerns, which Hywel Dda University Health Board, who runs the MIU, began acting on shortly after the inspection. The health board said it has been been using “surge” beds at the MIU for around two years, and that additional nurses were deployed there.
Keith Jones, the health board’s director of secondary care, said: “We accept the findings of the Healthcare Inspectorate Wales report, which has highlighted the challenges we have experienced in prioritising our facilities to manage the demand for urgent and emergency care at our hospitals.
“The report reflects the level of pressure we continue to face, which is itself symptomatic of the capacity challenges and the peaks in patient demand that our clinical teams across the health board have been dealing with since onset of the Covid-19 pandemic.
“In response to the specific recommendations outlined in the report, we have developed a detailed improvement plan with many of these actions already implemented.
“During times of peak pressure, we continue to use the minor injury unit to provide additional capacity. Staffing resources are continuously monitored and additional nurses are deployed to the unit to maintain the safety of patients. We also conduct regular patient flow reviews each day to prioritise patients to the most appropriate ward environments to meet their individual needs.
“To supplement these actions, we continue to implement our broader plans to improve the way in which we provide urgent and emergency care, not just within our hospital facilities but across our community services. We seek to maximise the number of patients who can be appropriately cared for as close as possible to their own homes.”
He added: “An inspection report like this never makes comfortable reading, however, I would also like to thank and pay tribute to our dedicated and professional staff who continue to provide excellent care in the face of significant capacity challenges.
“We must also acknowledge that as a health board – and common with many others throughout Wales and the UK – we have difficulty in attracting and retaining sufficiently experienced and qualified nursing and clinical staff to allow us to operate all of our MIU facilities.
“Unfortunately, this means that the MIU in Llandovery remains closed at the present time, as we do not have adequate staff numbers to operate it safety.”
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