Inspectors say “long waits and lack of social distancing” at Wrexham Maelor’s A&E must be improved urgently

Long waiting times and a lack social distancing measures at Wrexham Maelor Hospital’s A&E department must be improved “as a matter or urgency”, inspectors have said.

Officials from Healthcare Inspectorate Wales (HIW) reported ambulance crews were experiencing “significant delays” in handing over patients at the hospital, which has come under pressure during the coronavirus pandemic.

Concerns were also raised over a lack of safety measures to protect people from contracting Covid-19 in the emergency department’s waiting room following a quality check carried out remotely in November.

Members of the inspection team acknowledged that some issues raised during an earlier visit in August 2019 had been addressed, with patients no longer left queuing on trolleys in corridors because of the risk of infection.

However, in their report, they called for Betsi Cadwaladr University Health Board to take further steps to ensure people receive care in a timely manner.

They said: “During our interviews, we discussed that the Welsh Ambulance Trust were still reporting significant delays at the hospital.
“We were told that this year was particularly challenging due to COVID-19 and the need for patients to socially distance.

“We were told of measures taken to improve the site response, and whilst they had not reached a point where they would like to be, they are working towards improving the process to ensure they can safely offload patients within given timeframes.

“The measures being considered included opening an urgent care centre to support the emergency departments and treat patients who do not necessarily require emergency care.

“Consideration was also being given by the health board to a Welsh Government initiative whereby patients will be given appointments rather than waiting and overcrowding the emergency department.”

During December, the A&E department was one of the worst performing in Wales, with only 53.7 per cent of the 4,146 patients who came through its doors seen within the four-hour target.

The pressure placed on the hospital by Covid-19 resulted in bed capacity at Deeside’s rainbow hospital being increased to ease some of the demand.

An outbreak of the coronavirus within the Maelor also led to some beds being made unavailable, adding to the strain on the emergency department.

Problems with social distancing were highlighted after being raised by a member of the public.

The inspectors said: “We discussed an incident whereby a parent had attended the emergency department with their child and made a decision to leave as they did not feel safe due to a lack of ability to socially distance.

“It was explained to us that social distancing within the waiting area is a particular concern as capacity is limited due to COVID-19.
“Only 18 patients are able to be in the waiting room at the same time.

“We were told that a standard operating procedure is being developed to look at how patients can be kept safe within the waiting area. This is an ongoing piece of work.

“We recommend that the health board continue to monitor waiting times and implement the strategies described above and consider additional strategies as a matter of urgency to improve patient flow and patient safety in terms of social distancing throughout the department.”

As a result of the findings, the health board has been requested to provide the inspectors with further details of actions being taken to tackle the outstanding issues.

Betsi Cadwaladr University Health Board said it welcomed the inspectorate’s recognition of the progress made since the last visit.

Officials said concerns around social distancing in the emergency department have been addressed by carrying out temperature checks and increasing cubicle capacity, with measures also taken to improve waiting times.

Maureen Wain, hospital director at Wrexham Maelor Hospital, said: “A number of schemes have also been put in place to improve patient flow in the department.

“These include streaming suitable patients from triage directly through to our fracture clinic for review by the orthopaedic team, which provides more timely care.

“We were also successful in obtaining Welsh Government funding for an urgent primary care centre in our outpatient department.

“This targets on the day urgent primary care presentations and reduces unnecessary attendances into the emergency department.

“We will continue to work hard to address areas highlighted in the report where further improvements could be made.”
By Liam Randall – BBC Local Democracy Reporter