boys hospital - Healthcare Quality Commission (2023)

Updated July 23, 2019

Guy's Hospital is part of Guy's and St Thomas' NHS Foundation Trust and is located near London Bridge in the Southwark area of ​​central London. Guy's Hospital offers a range of inpatient medical and surgical services, both day and outpatient.

Guy's is a major center of choice for South London offering specialties such as; urology, orthopaedics, otorhinolaryngology and oncology services, including radiotherapy and chest and lung surgery. It has the largest dental school in Europe and has opened a dedicated cancer center since the last inspection. The hospital also operates an Accident and Emergency Department and provides community services within the local municipality.

The hospital has 400 beds.

Updated July 23, 2019

The assessment of the location takes into account previous assessments of services which have not been inspected on this occasion.

Our service score has remained the same. We rate it as good because:

• The hospital always had enough staff with the right qualifications, skills, experience and training to protect patients from avoidable harm and abuse, and to provide them with the care and treatment they needed. The staffing was adapted to the needs of the patients and the activities of the clinic. All employees understood their responsibilities to protect patients from abuse and neglect and received appropriate training and support.
• There was a well-integrated incident process and employees appreciated learning from the investigation process.
• Department heads had the knowledge and experience to lead and support employees. They fostered a positive culture, which the staff valued and respected. We chose to improve waiting times, patient access and the entire patient experience.
• Staff worked well with patients, staff, the public and local organizations to plan and manage appropriate services and collaborate effectively with partner organisations. Patient feedback was used to develop services.

However:

• Some of the planned service targets were not met. This included referral to treatment goals (RTTs) for all specialties and cancer services for patients who received their first treatment within 62 days of urgent GP referral.
• A significant number of patients had late follow-up appointments, which posed a risk for some. At some clinics, patients had long waits and were not always given a choice of appointment times.
• Medication administration was not always in accordance with the trust policy.
• Mandatory key skills training was available to all staff, but expected completion rates were not met.
• The facilities were not always suitable for the intended use and the privacy and dignity of the patients could not always be guaranteed. The equipment was not always handled safely.
• Staff did not always complete patient records to professional standards.

Updated March 24, 2016

Between April 2014 and March 2015, Guy's Hospital failed to meet its referral to treatment (admitted) target of 90%, but did so in 88.9% of cases.

There was a positive incident reporting culture. Staff understood and fulfilled their responsibilities to raise concerns and report incidents. Infection prevention and control measures met national guidelines and standards of cleaning and hand washing were consistently high and monitored regularly. There were plenty of doctors and RNs on hand, and staff numbers were updated four times a day throughout the hospital. Patients who deteriorated were seen by an experienced nurse specialist and their care was reassessed.

Staff were well supported with access to training, clinical supervision and development. Guidance from the National Institute for Health and Care Excellence was used in a variety of circumstances. The nutritional needs of the patients were assessed with recorded scores and identified risks. Oncology and hematology consultants were available seven days a week. Patients were asked for verbal consent to treatment and we observed that patients had signed treatment consent forms prior to medical procedures.

Patients received compassionate care and were treated with dignity and respect. Patients and family members and their relatives were positive about their experience of the care and kindness provided to them. Patients told us that they were involved in decisions about their care and treatment and that they received the right amount of information. The trust had a higher response to the Friends and Family Test (FFT) than the UK average.

We found evidence of patient outcome monitoring across several audits and national guidelines were used to inform patient care and treatment.

The hospital proactively managed the discharge of patients. When a patient's discharge was delayed, it was referred to the discharge team for progress. 74% (3,444) of patients did not change wards and were treated in the correct specialized bed during their stay. Patient needs were assessed and essential rounds of care were conducted at different times of the day. Complaints were handled through the Patient Advice and Liaison Service (PALS), investigated, learning points identified and feedback provided to staff.

The staff was awareof the vision of trust andthey included this as part of their daily work. The culture within the division was one of openness and honesty. District administrators regularly received reports about incidents, complaints, research results and personnel data. Trends could be easily identified and knowledge disseminated to staff. The employees indicated that they had the support of their managers and department heads. We found that staff and patients were involved in the development of healthcare services and saw examples of innovative practices.

Updated March 24, 2016

Patients achieved positive outcomes, including good safety thermometer results and a better mortality rate than other comparable units. This was due to evidence-based care provided by a number of competent staff. Patients could access the service without delay and there was an adequate patient flow through the department.

There was a positive safety reporting culture within the intensive care unit and the resulting investigations revealed learning points that were clearly communicated to ward staff. Patient records, including medication administration schedules, were completed and medications were administered appropriately.

The staff was concerned and maintained the privacy and dignity of the patient during his admission to the ward. We observe that staff treat patients with respect and obtain patient consent before performing care duties. Feedback from patients and relatives about the care they received was positive and there were good facilities for relatives. Few formal complaints have been received by the unit and we note actions taken in response to informal feedback.

Employees felt comfortable approaching the leadership team with any concerns and were encouraged to develop professionally. The management team had a good overview of the unit, but the vision for improvements in Guy's Critical Care Unit was minimal and the main focus for developing critical care within the trust was St. Thomas' Hospital.

Staff knowledge of security principles and deprivation of liberty was limited and good practices in these areas were not included. Staff evaluation rates were low: less than the recommended 50% of nursing staff earned an award after registration in intensive care nursing. We saw no immediate action to ensure adequate supplies of some drugs on weekends, leading some patients to miss doses of certain drugs for three weekends in a row.

Updated March 24, 2016

We saw that patients benefited from a multidisciplinary approach to care. General nurses and medical staff worked together with the specialist palliative care team (SPCT) to develop a cohesive plan of care.

The staff at Guy's Hospital provided competent and compassionate care to end-of-life patients. The SPCT was effective, providing face-to-face support seven days a week, including 24/7 community visits. Due to a staff shortage at the time of the visit, the watch was limited to visits until 9 pm. M. and the phone rang until 11 p.m. M. The turnover of consultants remained the same during this period.

There was good leadership from the SPCT. Employees found that senior managers were willing to help, offered support and guidance, were often seen in the departments and were very approachable. We found many practical examples, including the AMBER care package, and various training courses for healthcare personnel in the last phase of life, such as the training model Sage and Thyme, simulation days and Schwartz rounds. The staff of the funeral home had been given money to give family members sympathetically designed cloth bags so that they could more discreetly take home a deceased patient's personal belongings, rather than using a plastic mourning bag owned by the funeral home. Hopital.

The hospital had a long-term vision and strategic plan for end-of-life care. This had been prepared by outside consultants and staff noted that it was not fully feasible in its current form, but was being reviewed. Staff were clear that their goal was to provide individualized care, with quality outcomes and multidisciplinary input. The SPCT has embraced national guidelines in its end-of-life care protocols and practices, such as the NHS guide: Priorities for caring for the dying and a chance to get it right, developed by the Care Leadership Alliance Dying Persons (LACDP). . He also referred to the NICE quality standards for end-of-life care.

Bereavement support was available from a number of sources: funeral home staff, social workers associated with the SPCT, and the presbytery. We visited different wards and saw how patients were cared for with dignity and respect. The staff quickly discharged patients to their preferred place of death. Medications were provided according to guidelines for end-of-life care. Feedback from patients and family members, both in person during the inspection and collected by the hospital in its own bereavement survey, has been overwhelmingly positive.

The hospital was in the process of transitioning to fully electronic records. We found that staff had to use three different software systems as well as paper records during this process, leading to some confusion and uncertainty about where to find key information. This was particularly noticeable with the 'do not attempt cardiopulmonary resuscitation' (DNACPR) forms. It was found that there was no consistency in the recording of mental ability assessments.

From January to December 2014 there were 971 deaths at the Trust.

Updated July 23, 2019

We have previously inspected outpatients in conjunction with diagnostic imaging, so we cannot directly compare our new scores with previous scores. We rate outpatients as in need of improvement because:

• Medication administration was not always in accordance with the trust policy.

• The service did not meet referral to treatment (RTT) targets for all specialties. For cancer services, the trust performs worse than the operational standard for patients receiving their first treatment within 62 days of an urgent GP referral.

• The service provided mandatory key skills training for all staff, but failed to ensure that everyone completed it to meet trust targets.

• The service did not always have adequate premises or equipment and did not always take good care of it.

• Documentation in paper records and medication administration was not always in line with professional confidence and standards.

• The trust had many patients with late follow-up appointments and it was unclear how the trust managed the risks for these patients.

• The privacy and dignity of patients was not always ensured by the layout of some clinical areas.

• Patients told us that they regularly had to deal with long waiting times in the clinic and that they were not always given a choice of different times.

However:

• The service was adequately staffed, with the right qualifications, skills, training and experience to protect people from avoidable harm and to provide appropriate care and treatment.

• Effective systems existed to protect people from avoidable harm. Lessons learned from the incidents have been discussed at government and department meetings and steps have been taken to follow up on the results of the investigations.

• The leaders knew their services well and were committed to developing the service to improve waiting times, patient access and the patient experience.

• Services worked well with patients, staff, the public and local organizations to plan and manage appropriate services and collaborate effectively with partner organisations. Patient feedback was sought in a variety of ways and senior leaders engaged with staff to update them on significant changes.

• Managers fostered a positive culture that supported and valued the workforce.

Updated March 24, 2016

The trust instructed staff in May 2015 to use the five steps of the World Health Organization's (WHO) Surgical Safety Checklist in operating rooms, including information and equipment information components. Previously, staff were expected to primarily use the three core steps (login, timeout, logout). We saw some surgeons go through the five steps of the WHO checklist completely and exhaustively. However, we also found some inconsistencies in the application of briefings and debriefings by some surgeons.

We found good levels of cleanliness, infection control and hygiene in operating theaters and operating theatres. Staffing levels in wards and operating theaters were good, with very low utilization of banking and temporary staff, and there was good retention and management of nursing staff turnover. There was proper completion of mandatory training and effective incident reporting systems. We did find, however, that sharing lessons from incidents could be improved.

Surgical patients received effective care and treatment that met their needs and there was evidence of positive patient feedback. Your care and treatment is planned and delivered in accordance with national and local guidelines. Patients were treated with compassion, dignity and respect. Every patient we spoke to praised the staff for the care they provided and said they would recommend the hospital and its surgical services.

We have found a very effective multidisciplinary team working between doctors, nurses, physiotherapists and other paramedics. Information was shared proactively between staff groups to ensure proper coordination of patient care between departments and to help discharge patients more quickly. However, this effective team sometimes experienced delays in other areas of the hospital, particularly in obtaining prescription drugs from the pharmacy.

Surgical department leadership and culture fostered the delivery of high-quality person-centered care. The service had a clear vision and values. There was a lot of morale among the staff, especially in the departments. Staff were supported by their managers and there was a culture of openness to learn and develop services. Performance information was shared within each of the directorates providing surgical services, but we found limited formal structures for sharing management information between directorates providing surgical activities. The staff had the opportunity to provide feedback and inform the development of the service. They also received support from managers to develop their knowledge and skills to improve the quality of patient care.

Updated March 24, 2016

The trust had recently taken over responsibility for the service prior to the inspection and did not provide patient outcome data as long as it was specific to the UCC. Therefore, we did not know whether the UCC performed better or worse than comparable units.

The team working in the department was committed to providing a safe and efficient service that took into account the needs of the local population. Staff were trained to care for and treat patients with complex needs, and those who needed to be referred to a more appropriate service. Staff were trained to ensure that patients who were unable to communicate verbally could be assessed and treated effectively.

Our interviews with employees and review of departmental evidence showed that management and leadership structures resulted in a department that operated openly and transparently. This was reflected in the way employees dealt with reporting and investigating incidents and handling complaints. Learning from such cases was integrated into service planning and detailed root cause analyzes ensured that investigations were fair and thorough.

The handover processes in the department were well established and meant that ENPs consistently met the goal of seeing each patient within 15 minutes of registration. Patient attendance rates were monitored monthly and used to plan staffing levels to effectively meet peak times. The interactions we observed between patients and staff were positive, and the patients we spoke to told us they were satisfied with the service they received.

The environment was clean and orderly and staff adhered to established infection prevention and control policies. The equipment was well maintained and regularly checked. The storage of medicines met the requirements of the National Institute for Health and Excellence in Healthcare and the staff was well trained to administer medicines.