Reporting practices surrounding emergency department waiting times are to be ‘re-modelled’ across NHS Lothian following an internal review. An investigation, launched following a whistleblower’s revelations about the under-reporting of waiting times at St John’s in Livingston, has found that ALL emergency care hospitals across the region have misrepresented waiting times.
Board members will decide on a number of recommendations for emergency and front door departments after it was established that some reports do not comply with national guidance, meaning that numbers have been understated in performance reports.
Auditors have carried out a review of working procedures, relating to the four-hour emergency care standard, in all acute hospitals, including the Royal Infirmary of Edinburgh, the Royal Hospital for Sick Children and the Acute Receiving and Assessment Unit (ARAU) at the Western General Hospital.
The report containing recommendations has now been handed to the board and members will agree an improvement plan at the public meeting tomorrow (Wednesday 6th December).
It comes after an initial review was completed at the emergency department in St John’s Hospital into concerns raised by a whistleblower, suggesting that staff felt pressured and that numbers of patients waiting longer than four hours were higher than shown.
The report concluded that there were areas of non-compliance that required further investigation and that staff had been applying locally produced guidelines on how to record patients who breach the access standard, which did not comply.
As a result, each site with an emergency department or ARAU has been reviewed by NHS Lothian to assess if the issues relate to other hospitals and if data was being recorded correctly on other hospital computer systems.
The Lothian-wide report has found that other busy staff have also been using locally-created guidance, which has resulted in numbers also being under-reported from other sites.
The number of discharges which have been changed from a breach to a non-breach has increased over the last two years in NHS Lothian from 5.7 per cent in October 2015 to 10.5 per cent in September 2017.
The review, which was always due to come before this board meeting, has made a number of recommendations to address the anomalies and restore compliance.
NHS Lothian has already created a robust Standard Operating Procedure (SOP), instructed comprehensive staff training around it and begun development work to better support staff. The report advises improved staff training, greater monitoring and stricter governance, and said those measures could have prevented some of the practices earlier.
It said: “Throughout our interviews we noted a commitment and desire by staff to treat patients safely and patient care was their first priority.
“We recognise the need for a Standard Operating Procedure (SOP) to clarify procedures for staff at NHS Lothian. However this should be clear, subject to proper approval and version control and staff training and compliance monitored.
“Local procedures were developed to mitigate for an unclear and perhaps out of date SOP. Local procedures should not be allowed to be developed.
“There should be greater reporting and transparency over ED performance at appropriate levels of the organisation to help teams better understand the position, investigate unusual practices or misunderstanding and share lessons.”
Jim Crombie, Deputy Chief Executive, NHS Lothian, said: “The report has made a number of recommendations and the board members will discuss them in greater detail. We have already put several of them into place, including the creation of a Standard Operating Procedure and created staff training.
“We also have to do work with our teams across NHS Lothian to help them feel supported and that will feature as a key strand in our development plans.
“As soon as we received these initial concerns, an internal audit team was appointed, headed by a senior non-executive director to oversee the investigation.
“We now have the results and the recommendations from that report and we will develop a plan to ensure effective action is taken.
“NHS Lothian is committed to the values of openness and transparency and we have placed them at the heart of our organisation.
“We have a robust Whistleblowing Policy in place to ensure that all our staff are supported and feel able to raise any concerns and I am grateful to them for stepping forward.”
Following receipt of the Whisteblower’s letter, the Cabinet Secretary for Health, Shona Robison, requested that NHS Lothian carry out an internal investigation into the concerns raised.
Following receipt of the interim internal report, the Cabinet Secretary for Health immediately asked the Scottish Academy of Medical Royal Colleges Academy to carry out an external review. This commenced last week.
It is then expected that the external review team will report back to the Cabinet Secretary early next year and the report will be submitted for discussion at the following public board meeting on NHS Lothian in February.
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