Staff in the Royal Victoria Hospital’s Emergency Department are operating in a “toxic” environment due to ‘overcrowding’, a new report has found.
It also said that the emergency department “continues to function well beyond its capacity and outside its core purpose.”
The Regulation and Quality Improvement Authority (RQIA) report, released on Thursday, found that staff were training in “chaos” while overcrowding within the ED “continues to impact upon the safety of patients and of staff”.
The report was ordered as a follow-up after an inspection of the ED between November 2022 and February 2023 found a number of areas for concern.
The inspection found that overcrowding within the hospital was extending the service “well beyond its capacity and outside its core purpose”.
The follow-up inspection was carried out between November 2023 and January 2024, with Thursday’s report finding that the Belfast trust had met three of the nine improvements recommended in the original report.
In its latest findings, consultations were held with staff members who described the environment within the ED as “toxic”.
“Medical staff reported the current ED is not conducive to staff training, and that ‘staff train in chaos’,” the report states.
“The environment was described as ‘toxic’, stress levels were reported as high resulting in ED staff resigning from their posts due to the enduring pressure.
“It was reported that previously staff had favoured working in the RVH ED, but now ‘won’t stay once their training has completed’.
“It was further purported that introducing any additional medical staff may have a limited effect, as there is no surplus clinical space to treat patients.”
Increased numbers of patients waiting in corridors have made it difficult for staff to access hand-washing facilities and for cleaning to take place within the ED.
“Staff reported that IPC (Infection Prevention and Control) is difficult to control and challenging due to over-crowding.
“Examples of this included the ability to access hand washing facilities when patients are being cared for in corridors, and the ability to physically access overcrowded areas to fully complete environmental cleaning.
“Housekeeping staff were reported as committed and continually clean any free spaces, but this was reported as virtually impossible to maintain due to overcrowding.”
The report noted that “some progress had been made’” but that the ED “continues to function well beyond its capacity and outside its core purpose.”
While it went on to note areas such as internal communication between staff which can be improved by Trust staff, it concluded: “Most of the issues that are at the heart of overcrowding are attributable to wider system pressures, which need a strategic regional approach and centrally led reform.”
A spokesperson for the Belfast Health and Social Care Trust said it was committed to addressing issues at the hospital under its control, but added most issues referenced in the report were ‘attributable to wider system pressures’.
“While progress has been made in some of the areas identified, including communication with frontline clinical staff and a workforce review, our Emergency Departments continue to face unprecedented demand and overcrowding,” the Trust said.
“As recognised in the report most of the issues that are at the heart of overcrowding are attributable to wider system pressures, which are felt across the region.
“Belfast Trust are committed to addressing the issues within our control, and we pay tribute to the dedication of all our staff who continue to work in very challenging circumstances.”
