Peterborough City Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We rated effective as good. We assessed 4 quality statements. Staff assessed people so the care and treatment met their needs. This included both their mental and physical health needs. Staff worked in a culture of evidence-based practice. Staff worked together with others when assessing people’s needs and shared information to maintain continuity of care. We were concerned that staff compliance with screening assessment tools was still low after an inspection in 2022.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff assessed and acted on risks to patients to protect them from avoidable harm. Staff used a patient safety checklist tool for screening patients within the first 2 hours of the patient's stay within the U&EC department. Screening tools included a falls risk assessment, a skin assessment body map and a Waterlow pressure ulcer risk assessment. In addition, a sepsis screening tool must be completed within 1 hour if certain criteria are met and then every subsequent hour after that. During our inspection in 2022 we told the service that it must improve staff completing risk assessments. At this assessment we found that staff compliance with the patient safety checklist screening assessment tools was still low with overall compliance of 54% in June 2024. This means that patients maybe at increased risk of deterioration and harm.

Staff had access to specialists for advice and support. This included access to a Learning Disability team. Staff felt they had the correct support and training to meet patients’ needs.

Staff were observed discussing people’s needs with them, and they were involved in how care and treatment was planned.

Staff effectively communicated with patients to meet their needs. For example, one member of staff communicated patiently, kindly and compassionately with a patient who had a hearing impairment. We also observed a patient who had suffered a suspected stroke and was clinically assessed at regular intervals by staff involved in their care and a patient with suspected neutropenic sepsis had also been appropriately clinically assessed. We did observe one patient with mental health needs who needed support for food and hydration which had not been met straight away.

A new process had recently been introduced to improve the initial assessment of patients’ needs on immediate arrival at the U&EC department by a senior nurse. The aim was to triage/stream patients so they would then be reviewed in the appropriate area. This had only been introduced recently and needed to be evaluated.

Patient records were reviewed. These were generally completed comprehensively for children and young people and adults. For adult patients with a mental health condition, a mental health risk assessment was not always carried out. During our inspection in 2022 we told the service that it must improve record keeping of patient’s care and treatment. At this assessment, we found the service had made improvements, but risk assessments were still not always completed.

People we spoke with did not raise any concerns about receiving care that did not meet evidence-based practice. People were generally satisfied with their care although they did have to wait a long time on occasions. In June 2024 there were 11.9% of patients waiting 12 hours or more in the U&EC department, with an average of 13.9% patients waiting over 12 hours in the preceding 6 months.

Staff used the service’s systems and processes to follow the latest guidance and evidence-based practice. The service kept its database and guidance up to date. Staff told us they found the weekly message from the U&EC clinical lead useful and received briefings and newsletters. Staff told us that they used the patient safety checklist. This had been endorsed by external organisations such as the Royal College of Emergency Medicine (RCEM) and allowed effective screening of patients after first being seen.

There was mixed feedback from staff regarding the initial streaming/triage/use of assessment tools when patients arrived at the U&EC department and how observations were gathered to inform risk.

Staff followed up-to-date policies to plan and deliver quality care according to evidence-based practice and national guidance. We reviewed a sample of the service’s policies and guidelines and noted that all were in date with a set review date. Staff used evidence-based, standardised risk assessment tools to identify the level of patient risk for areas such as falls, skin and pressure ulcers.

Leaders encouraged some innovation and participation in development opportunities. We were informed by leaders and staff about a band 6 development programme for nursing staff. The team was able to organise protected time for two-hour monthly sessions. It was proposed to rotate the development opportunities between various bands of staff.

Examples of innovation in the U&EC service also included: the early stages of adopting a new process of assessment of patients at the front door of the U&EC department. Patients that came in at the front door often did not have a healthcare professional with them and the initial assessment they received when they arrived could often be clinically vital, especially if they were poorly. The new process involved patients being initially assessed by a senior U&EC nurse within 15 minutes and being allocated a category, which would enable them to be seen much more quickly by senior U&EC clinicians. At the time of our assessment, leaders and staff told us that the U&EC team were piloting the use of a national acuity assessment tool. The senior clinicians included U&EC consultants/middle grade doctors and advanced clinical practitioners. In this way the decision about care was immediate and they could also order investigations, plan care and prescribe medication. These changes would improve waiting times and journey times for patients through the U&EC service. The service’s next steps included protecting space in the “fit to sit” cubicles to see patients.

People told us they were satisfied with the care provided by the U&EC team working together. Medical and nursing staff worked together to assess, plan and deliver peoples care and to meet their needs.

There was feedback from staff that staff, teams and services work well together. There was feedback of joint working with the medical services team and with the U&EC team at another NHS hospital. There was joint working with the frailty team to review frail patients who attend U&EC services via an ambulance. Patients with a high frailty index score may deteriorate quickly so the frailty team could work as an admission avoidance service. The frailty service was co-located in the ED department. A project had also been undertaken with the services pharmacy team to improve timely dispensing of medicines for discharge.

There was system-wide work taking place which included some discussions around the concept of a U&EC village with same day care being provided and expansion of virtual ward care. There was a good working relationship with the local NHS ambulance service provider. There had been a benefit in having a Hospital Ambulance Liaison Officer (HALO) in place with the benefit of providing mutual recognition of the challenges that each organisation faces. Eligibility criteria had been agreed for both corridor and ambulance care of patients. There was still some concern about tracking deteriorating patients, but the U&EC and ambulance service was working well together.

The service also worked with the ambulance service to reduce delays in ambulance handover times. Ambulance staff we spoke with were positive about the improvements the service had made to reduce handover times.

Staff held regular daily “10-minute huddle” meetings to ensure that patient flow was maintained efficiently. For example, the matron and doctor discussed issues that needed to be chased up. Staff also informed us that the introduction of a “pitstop” area near the ambulance offloading bay had been a positive development. There was a better process to track patients who may need to be escalated if there were concerns about their deterioration.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients informed us that generally they had good communication from staff. Daily huddles were held to support transition of care to other services when facilities were available. The frailty team was co-located in the U&EC department and supported the assessment of frail patients to avoid admission and improve outcomes.

The service provided care and treatment based on national guidance and evidence-based practice. Staff assessed and monitored patients to ensure that their treatment was effective to improve outcomes focusing on acute unwell and time critical patients.

We were told that there were some concerns about patients not receiving time critical medication on occasions for example patients living with Parkinson’s disease. The service had a quality improvement project looking at improving prescribing regular medication for patients that had been admitted but were still in the U&EC service. A junior doctor had been employed just to review patients on day 2 of their admission in the U&EC service. This was a useful role to ensure patients were followed up after initial admission and improve outcomes.

The service had a clinical audit plan for 2024/25 to improve care, outcomes and provide assurance. The planned audits involved participation in several Royal College of Emergency Medicine (RCEM) audits for example, adolescent mental health, and care of older people.

The service had been involved in national clinical audits, for example, RCEM Infection Prevention and Control audit to improve outcomes aiming to improve standards of patient care whilst improving staff experience and outcomes through preventing occupationally acquired infections. However, there was limited evidence of local audits being undertaken with only one on the clinical audit plan. This was an audit of the management of burns in paediatric patients in the paediatric ED. Only 10% of patients had wound management for burn injuries as part of local criteria and only 37% of patients were referred appropriately to a local burns service. There were only two re-audits scheduled for head injury in children and fracture neck of femur. There was limited assurance that clinical effectiveness audits were carried out regularly and that learning was identified in a timely manner to support effective care of patients and improve outcomes.

There was evidence that the service held regular morbidity and mortality meetings and that cases were discussed to improve learning and outcomes. The service undertook reviews and monitored quality improvement projects. These were discussed each month at the performance and improvement committee to improve quality of care. Examples of the types of improvement projects included the planned introduction of automated observation machines when patients arrive at the U&EC reception as part of the initial assessment process. Also, installing more personal computer screens in patient bays to improve access for medical staff and provide information for patients, and the creation of a better environment for patients in the corridors.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.