'Urgent action' needed to protect A&E staff from violence

Hospital staffing levels fell below the recommended number for the size of the department

Accident and emergency staff at Bristol Royal Infirmary do not feel equipped to deal with the violence they face from the public, inspectors have found.

Health watchdog The Care Quality Commission (CQC) rated the department as "requires improvement" following an inspection in February.

It said "urgent action" must be taken to protect staff and patients.

University Hospitals Bristol and Weston NHS Foundation Trust said it was working on improvements.

Amanda Williams, CQC's head of hospital inspections, said: "We were... particularly concerned to find high levels of violence and aggression against staff from patients in the department and to learn that staff did not feel adequately trained to deal with this.

Twelve-hour wait

"Staff need to be given the appropriate training and support to ensure they feel safe and to enable them to defuse tension and prevent violence from escalating."

The inspection also found high demand, Covid-19 restrictions and a lack of beds across the hospital meant patients did not always receive care and treatment promptly and the service did not have enough medical staff to meet the recommended guidance for the size of the department.

Ms Williams said: "Unprecedented numbers caused by the Covid-19 pandemic meant that some patients were waiting on trolleys for more than 12 hours".

She advised the hospital trust to ensure it had adequate staffing at all grades to run a same-day emergency service and cut down the demand for overnight beds.

The report said patient handover from ambulance crews and waiting-time performance was worse than NHS national standards.

She also noted that hygiene and safety standards should be upheld in patient waiting areas.

The report made some positive observations noting that staff understood how to protect patients from abuse, and patients had an assessment of their infection risk and other clinical risks on arrival at the department.

Inspectors also noted comprehensive records were kept and staff felt respected, supported and valued.

Deirdre Fowler, interim chief nurse at University Hospitals Bristol and Weston NHS Foundation Trust, said: "We recognise there are areas for improvement including concerns about the growth in violence and aggression to staff from patients, and ambulance handover and waiting-time performance for onward admission to the hospital.

"We have introduced a 24-7 security presence and extended CCTV coverage in the department, personal alarms, and body-worn cameras."

She said the trust was also delivering enhanced training to help staff de-escalate and manage violent or aggressive patient behaviour.

The previous CQC inspection rated the emergency department as requires improvement and owing to the narrow focus of the latest inspection the overall rating has not changed. The CQC rating for the UHBW site as a whole is outstanding.