Birmingham Heartlands Hospital

Updated 14 February 2024

Birmingham Heartlands Hospital is an acute general hospital in Bordesley Green, Birmingham. The hospital is part of University Hospitals Birmingham NHS Foundation Trust and is based on a large site in a purpose-built facility. Birmingham Heartlands Hospital provides a range of outpatient, inpatient and emergency care services for its local community. These include maternity services, services for children and young people, medical services and surgical services.

We completed unannounced visits of the Urgent and Emergency Department due to information of concern. We also completed a follow up to the Pregnancy Assessment Emergency Room within the hospitals maternity services.

Updated 13 February 2019

• Information provided by the trust and information directly from staff did not demonstrate that all staff had completed the relevant level of safeguarding children training in accordance with the Intercollegiate guidance: Safeguarding Children and Young People: Roles and competencies for Health Care Staff (March 2014).
• There were significant staffing vacancies across the whole of the medicine services which impacted negatively on patients care and treatment and staff morale.
• Staff did not always follow trust policy in regard to the safe storage of medicines. Room temperatures and refrigerator temperatures were recorded out of acceptable range and staff were unsure as to what actions were required in response to this. Intravenous solutions with potassium were not always stored separately from other intravenous solutions.
• Staff did not always follow trust policy in regard to control of substances hazardous to health (COSHH). We found chlorine based solutions which were left on the side in rooms which were unlocked.
• Patients who lacked capacity were not always assessed according to policy and where patients were deprived of their liberty this was not always done so lawfully.
• Patients with sepsis were not always appropriately screened and treated in line with national guidance and local trust policy.
• The trust had implemented an escalation measure called ‘safer patient placing’ which required wards to board additional patients until discharges occurred. This had increased the risk on some wards due to having no official bed space for patients and increasing the number of patients on the ward.

However:

• Staff monitored changes in patients’ conditions using a nationally recognised system and escalated patients appropriately when required.
• Staff working within specialised areas were well supported by senior colleagues and practice educators and had comprehensive competency documents to develop them professionally.
• Patients were generally cared for in a dignified, respectful and compassionate manner.
• We observed evidence of learning from incidents and complaints around the medical wards, with local quality improvement initiatives introduced to improve patient care.

Updated 19 April 2023

Updated 14 February 2024

Updated 13 February 2019

We rated this service as requires improvement because:

• We identified some concerns in relation to the environment in the operating theatres. The airflow exchange in parts of the operating theatres did not meet with Department of Health guidance. In addition, we found the contents of emergency trolleys used in the operating theatres were not always checked daily, which had the potential to impact on the safety of care.
• Processes to ensure the safety of patients undergoing surgery were not always followed in theatres. In particular, we found variable compliance with the surgical safety checklist and premature completion of instrument checklists. The consistent use of these checklists is key to eliminating surgical errors.
• The service had enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm. However, we identified concerns in relation to out of hours provision, the volume of general surgical emergency patients and the high use of temporary staff. This impacted on the timeliness of care and the pressure on medical staff out of hours.
• Medicines were not always managed safely. We observed two occasions on a ward when a medicines trolley was unlocked and unattended. Storage areas were congested and we saw there were occasions when a medicine was missed due to staff being unable to locate it, or there were delays in obtaining a medicine from pharmacy. The temperature of refrigerators used for medicines storage on the wards were not monitored consistently and when they were above recommended limits, action was not always taken to report this to pharmacy.
• Staff recognised incidents and reported them appropriately. Managers investigated incidents and action was taken to prevent recurrence. However, staff did not always receive feedback about incidents and lessons learnt were not always effectively communicated to staff, particularly in relation to learning from incidents on other sites.
• Patient feedback about the quality of the food and choice was variable and some patients told us this affected the amount they ate.
• Consent was obtained in line with legislation and when patients did not have the capacity to make specific decisions, the principles of the Mental Capacity Act were followed for surgical procedures. DoLS applications were submitted to safeguard patients when necessary. When patients were unable to consent to their care, staff were able to describe how they acted in their best interests; however, nursing documentation of mental capacity assessments and best interest decision making was not always completed.
• We spoke to three patients on one ward who felt there was a lack of communication between departments which impacted on their ability to obtain information about the plan for their care.
• Matron and manager support to individual wards and the operating theatres was variable.
• There was little engagement or understanding of governance issues below band 7 level.

However:

• The service provided mandatory training in key skills to all staff. Overall completion rates for nursing staff were above the trust target of 90% and all modules were above 80%. Overall completion rates by medical staff were below the target at 82% although completion of most modules was above 75%
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had a good knowledge of their responsibilities to report safeguarding concerns and make referrals. They were supported by the trust safeguarding team to do this.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. Audits were completed to ensure staff adhered to national guidance.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Audits were completed to make sure staff followed guidance.
• Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
• Staff gave patients enough food and drink to meet their needs and improve their health. Patients had access to specialist advice and nutritional support as required.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them. Performance in national outcome audits was variable with good outcomes in the national vascular registry, national emergency laparotomy audit and the national bowel cancer audit for example, whilst performance in the national hip fracture database audit was below the national average.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance to provide support and monitor the effectiveness of the service.
• Multidisciplinary team working was effective. Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide coordinated care. We observed therapies staff were based on some wards and staff communicated well with each other.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff maintained patients’ privacy and dignity and showed concern about their welfare.
• Staff provided emotional support to patients to minimise their distress. Patients were supported by ward staff and specialist nurses.
• Staff involved patients and those close to them in decisions about their care and treatment. Most patients were aware of plans for their care and treatment and said they had been provided with the information they needed to help them make decisions about their care.
• The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care
• The service used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. We found examples of discussion at specialty and divisional level to identify improvements to the quality, safety and effectiveness of care.
• The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Risks were clearly identified in the divisional risk registers.
• The trust collected, analysed, managed and used information well to support its activities. Most records were paper based and when electronic systems were used, security safeguards were in place.

Updated 14 February 2024