Page last updated at 16:23 GMT, Tuesday, 17 March 2009

Key problems at 'shocking' hospital

Stafford Hospital has been heavily criticised by the NHS watchdog over the care it provided to emergency patients.

Among the findings, were a series of startling revelations about practices at the hospital.

RECEPTIONISTS ASSESSING PATIENTS

It almost seems unbelievable, but during the past three years receptionists were used to assess patients arriving at A&E.

The Healthcare Commission reported that the receptionists - who did not have any clinical qualifications - were used to categorise patients as either major or minor.

They were also given responsibility for checking on their condition in the waiting room because of the lack of nurses.

The watchdog was given examples of where patients suffered. A senior doctor told the inspectors about a patient with a broken elbow that pierced the skin.

The man, after being assessed by receptionists, was left bleeding and with no pain relief in the waiting area for four hours.

In another case, a patient with a history of heart problems was kept waiting for 40 minutes before getting care.

LACK OF DOCTORS

As well as a shortage of nurses, the emergency service at Stafford Hospital suffered from a lack of senior doctors.

From September 2005 to March 2008, the A&E department operated with just two emergency consultants when it should have had three.

For many months after that there was just one, making 24-hour cover impossible.

It meant the trust had to rely on senior doctors not specialising in emergency medicine or middle grade doctors.

And it culminated in a two-week period when there was no consultant or middle grade cover at all during the night.

THE TARGET CULTURE

Staff told the Healthcare Commission that there was "pressure, pressure, pressure" on them to meet the four-hour A&E waiting time target.

Several doctors recounted occasions where managers had asked them to leave seriously ill patients to treat minor ailments so the target could be met.

One gave an example of being asked to leave a heart attack patient being given life-saving treatment.

Nurses reported leaving meetings in tears after being told their jobs were at risk after breaching the target.

And the watchdog concluded patients were sometimes "dumped" into wards near A&E with little nursing care so the target could be met.

This led to delays in things such as x-rays as well as putting patients at risk.

RESUSCITATION

Resuscitation is a key part of any emergency service provision, but the watchdog identified a range of serious problems.

In September 2006, a patient being resuscitated was given a pain relief drug, which suppresses heart rhythms, after it was mistakenly placed on a resuscitation trolley.

The Healthcare Commission also unearthed several internal reports about the lack of suction equipment on trolleys for patients with breathing problems.

And the watchdog highlighted the confusing array of different models of resuscitation trolleys.

Most hospitals will have a standard type of trolley so staff - particularly agency workers - are familiar with the equipment they are using.

A junior doctor also told inspectors about a incident when they were bleeped during the night as a patient had stopped breathing.

He arrived on the ward 10 minutes later to find he was the first person there. The nurse who had raised the alarm had not alerted the crash team.

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