Dr Gray's Hospital inspection report: "Severe overcrowding", six hour waits in ambulances and medication "unaccounted for"
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By Ewan Malcolm and Lewis McBlane
INSPECTORS have raised "serious concerns" regarding Dr Gray's Hospital with "severe overcrowding", lengthy waits in ambulances and "blood contaminated" mattresses among the issues highlighted.
Unannounced inspections from Healthcare Improvement Scotland (HIS) took place between October 9 and October 11 last year.
In a report published today, the hospital was found to have two areas of good practice.
It was described as "calm and well organised" and "positive and caring" interactions between staff and patients were observed.
However, inspectors have outlined 20 requirements where Dr Gray's has not met the required standards which the hospital must address.
These included concerns around senior management, safe storage of medicine and the cleanliness of patient care equipment.
A less severe "recommendation" to ensure that patients are assisted with "hand hygiene" at mealtimes was also made.
Donna MacLean, chief inspector for Healthcare Improvement Scotland, said: "During our inspection at Dr Gray’s Hospital, we raised serious concerns regarding the management of controlled drugs within the emergency department and in the oversight and management of the incident reporting systems and processes impacting on patient safety, dignity, and respect at Dr Gray’s Hospital.
“We observed evidence of failures to review, action and close incident reports relating to patient safety, privacy, and dignity and staff concerns around workload and culture, particularly in the emergency department.
"Staff reported a culture where they were encouraged to raise concerns but did not feel that these were always listened to by senior managers.
"We have further concerns about the availability of staff training in paediatric immediate life support and the systems and processes for patient triage in the emergency department."
It is understood that staff were briefed about the report earlier this morning.
In it, inspectors found "severe overcrowding" at the hospital's emergency department which on occasion operated at 200 per cent capacity.
The report noted that, at one point, five patients were being cared for on trolleys in the corridor with others sitting in chairs.
That is despite NHS Grampian guidance stating there should be a maximum of two patients in the corridor.
According to the report: “Staff describe that patients did not have access to adequate bathroom facilities, privacy and dignity was compromised and there was reduced provision of food and fluids."
It added: “Several incidents described staff feeling overwhelmed, unable to provide care and not feeling supported by senior managers, including the site and capacity team, with staff unable to take their breaks overnight.”
Some patients were forced to wait outside in ambulances for "up to six hours waiting for available space within the department."
However, the report did not "observe any significant delays in ambulance turnaround times."
Inspectors raised concerns about children's life support training offered to staff.
The report said: “Staff we spoke with told us there is no current paediatric immediate life support training provision at Dr Gray’s Hospital.”
It added that some children initially deemed stable and transferred to the paediatric ward "required immediate treatment on arrival as their condition was not stable.”
NHS Grampian is set to introduce paediatric life support training later this month.
However, the way emergency department patients were prioritised was also criticised.
The report noted that "patients were not prioritised according to clinical need".
It details that "a patient had become critically unwell" after an 80 minute wait for triage.
While the "majority of patient care equipment appeared clean" inspectors found that "the blood gas machine and two patient trolley mattresses were contaminated with blood."
Wear and tear in the emergency department was also highlighted, including "use of tape to repair flooring".
NHS Grampian has also been ordered to improve its handling of controlled drugs at Dr Gray's.
Inspectors found some drugs were "unaccounted for" and medication was found at reception without the correct pharmacy paperwork.
Issues with ward staffing were also highlighted.
The report also said senior charge nurses "did not have time" to review adverse incidents because they were providing care.
Consequently, inspectors found that 186 incidents missed the review deadline – 42 of which were more than a year late.
In the wake of the visit, inspectors said a "prompt and positive response by NHS Grampian" had reduced the number awaiting a review.
However, the report praised staff for providing "compassionate and responsive care" noting that patients had been "complimentary".
Professor Duff Bruce, Dr Gray's Hospital clinical director, welcomed feedback from the report while highlighting the pressure that the hospital is under.
He said: "The pressure on Dr Gray’s emergency department is unprecedented. An astonishing 4973 extra patients were seen in 2023, with a record 29,580 people requiring our urgent help and expertise.
“In spite of these demands our staff continue to do a remarkable job and to perform better than the Scottish average.
"That’s a testament to their hard work but it doesn’t mean we will be complacent."
Alasdair Pattinson, hospital general manager, added: "Our goal is to make Dr Gray's one of the best local hospitals in the country.
"We are grateful to HIS for their feedback and will use this as a springboard to further improve services."
NHS Grampian has developed an "improvement action plan" to meet the requirements at Dr Gray's Hospital.
The health board will be required to meet several deadlines over the next year.
