REACH has always argued Gloucestershire Royal Hospital does not have the capacity to handle all the emergency cases from across the whole county. There is insufficient space to accommodate all the ambulances in peak periods. The waiting room in A&E is not big enough to accommodate all the patients waiting in peak periods. The A&E Department does not have enough cubicles to accommodate all the patients who need to be seen at peak periods. The Hospital itself does not have enough inpatient beds to accommodate all the emergency patients admitted from A&E.
REACH accepted it might not be possible to guarantee to keep Cheltenham General Hospital Covid-free after being designated as a ‘Green’ hospital, if the Type 1 A&E Department remained open. Consequently we reluctantly accepted its temporary closure as a Type 1 A&E Department and its downgrading during the day to a Minor Injury & Illnesses Unit, for an initial period of three months from 9 June.
However, our original assessment of A&E capacity at GRH has been proved correct. For four days in the week commencing 10 August, the Hospital Trust had to declare an ‘Internal Critical Incident’, because of “unprecedented demand for urgent and emergency services” – although this cannot have been true, because across the country there has been a 30% drop in A&E attendances!
One consequence of the overload in A&E at GRH has been delays to ambulance handovers. Ambulances are meant to be turned round in 15 minutes and the Hospital Trust is fined if they are held for more than 30 minutes and fined even more if they are held for more than one hour. Since the diversion of all emergency ambulances from Cheltenham, there have been several occasions when up to three patients have been held on ambulance beds in the car park!
The day after the ‘Internal Critical Incident’ was lifted one ambulance was held for two hours. Last week another ambulance was held for 108 minutes and two Category 1 Emergency Calls were missed as a result. Now the Hospital Trust has been forced to address the problem of delayed ambulance turnarounds. With effect from Tuesday September 1, at just four days notice over the Bank Holiday, the Hospital Trust is trialling a new procedure intended to “improve ambulance hand over times, improve safety of patients in the corridor and improve time taken for a patient to see a clinician – a clear admission the previous situation was compromising patient safety.
“From Tuesday September 1, between the hours of 1pm-8pm and EXCLUDING weekend” the Hospital Trust “will operate a ‘pit stop’ process.” “For ‘Green’ (low-risk COVID patients)” the ambulance crew should be met by a “pit stop team who will off load the patient into a cubicle in the area of cubicles 22, 23, 24.” The “pit stop team will be made up of a senior decision maker (Consultant or Registrar), Band 3 Nurse, Junior Medic and a Receptionist. This should facilitate rapid hand over and booking in. The team will then make an initial rapid assessment of the patients needs and endeavour to undertake initial investigations and instigate time critical treatments before moving the patient onto an appropriate clinical area either in the ED or other ambulatory space.” That begs the question of why this is not being done anyway.
“Pre-alerts for critically unwell patients would continue as usual and if directed to enter the resus area directly upon arrival the ambulance crew will not be met by the pit stop team but met in resus as per current arrangements.”
“Conveyance of any ‘Red’ (high risk for COVID) patients should continue as per usual.”
“Outside the trial hours, ambulance crews should continue to book in nd meet triage/corridor nurse as per usual process.” The very existence of a “Corridor Nurse” is an admission the system does not have the capacity to cope with the demand.
This notice was sent to all ambulance crews by the Hospital Trust’s ED Quality Lead. One of whom commented:
“For me and my colleagues this is a pointless 7 hours each week day trial that won’t work as the corridor on entry is continuously rammed, once those three cubicles are full where to next? Oh yeah the corridor!”