Inspection of Emergency Department at The Grange University Hospital Highlights Progress and Continued Challenges

It was disappointing to find that overcrowding in the waiting room and reception area continues to compromise patient privacy, dignity, and access to timely care. This was compounded by delays in patient flow, largely driven by system-wide discharge challenges that have a knock-on effect on the department. 

Inspectors were concerned about insufficient staff oversight in waiting areas, delays in completing risk assessments, and instances where patients did not receive timely pain relief. HIW asked for immediate improvements to be made in relation to risk assessments, medicine management, and equipment checks. 

Improvements had been made since our previous inspection, including the introduction of an electronic triage system which has helped improve the efficiency of patient triage processes, and ongoing construction of an extended waiting area, which aims to alleviate overcrowding and improve staff visibility.

While nurse staffing levels remain under pressure, these have stabilised compared to the previous inspection, with less reliance on agency staff and improved retention. Inspectors noted the impact of enhanced training and support initiatives, including a dedicated practice development nurse. Over 85% of staff have completed mandatory training, and systems to capture patient feedback, such as QR codes, are now in place to help improve services.

Despite these improvements, systemic pressures persist. There was a persistent high escalation status across the health board at the time of our inspection, with delays in discharging up to 400 patients. Renovation work on the department’s waiting area is progressing but will not be completed until spring 2025, delaying any immediate relief.

Inspectors commended staff for their professionalism, compassion, and commitment to delivering care under challenging conditions. However, the department remains under pressure, and systemic issues within the health board and the wider NHS continue to impact the consistent delivery of timely care.

Alun Jones, Chief Executive of Healthcare Inspectorate Wales, said:

"This inspection highlights both the dedication of staff working under immense pressure and the significant challenges that remain in delivering safe, timely, and dignified care. We are encouraged by the progress the department is making, but further improvements are urgently needed to address systemic issues affecting patient flow and care delivery. HIW will continue to work closely with the health board to ensure the necessary changes are implemented, so that patients receive the high-quality care they deserve."

October 2024 - Hospital Inspection - Emergency Department - The Grange University Hospital, Cwmbran