STAFF in the emergency department at Swindon’s Great Western Hospital flagged up 121 separate 'unsafe' incidents in the first four months of this year, a report has revealed.

An internal ‘red flag’ system was used to raise the alarm 24 times in January, 32 times in February, 41 in March and on 24 occasions in April - figures for the following months are not yet available.

Triggers included delays in patient assessment and review, patients queuing, patients’ essential needs not being met, staff not being able to take adequate rest periods and staff feeling overwhelmed, stressed or unable to cope.

The level of staff concern was revealed in a report by the Care Quality Commission following a surprise visit to GWH in April.

In December, a warning notice was imposed on the emergency department at the hospital and assurances were provided that remedies to the problems highlighted would be in place within months.

However, the new report finds that many of the failings are still happening and that the changes required by the warning notice have not been satisfactorily implemented.

Inspectors found that risks to patient safety were not always addressed fast enough and that up to date records were not always maintained.

The report highlighted a serious incident in December where a patient collapsed in the waiting room of the emergency department and later died.

The patient had been pointed out to clinical staff due to particular features of their medical history but despite this, they had not been triaged when they collapsed, some 49 minutes after arrival.

In February a patient with a known lung disease had to be treated in a corridor, they were left with a portable oxygen cylinder which then ran out.

When inspectors dug deeper into the incident they discovered that the patient’s vital signs hadn’t been taken for nearly two hours.

In both cases, inspectors said: “We were not assured that adequate safeguards had been put in place to prevent a similar incident.”

The emergency department’s observation unit was the focus of previous criticism and inspectors recounted an incident where due to staffing shortages, it became “dangerous with a patient who was aggressive”.

A lone nurse was left to man the ward when the staffing plan said an additional registered mental health nurse was also required – security and police were called following the incident which left elderly patients afraid and in need of reassurance.

In February, it was reported to a steering group within GWH that “staff are no longer coping with the demands of the levels of activity in the emergency department”.

While the overwhelming tone of the report was that insufficient progress had been made, inspectors did praise the improvement plans put in place to put the department on the right track.

An additional layer of management support had been brought in which was seen as a positive step and nurse staffing levels had risen by 20 per cent.

Staff had received additional training to deal with mental health patients and children and an additional security presence in the department had increased safety levels.

The CQC has said it will continue to monitor the emergency department at GWH.

It has decided not to lift the warning notice imposed in December last year and inspectors are expected to visit again in the coming months.

The Great Western Hospital NHS Foundation Trust was quick to respond to the CQC report, highlighting the positive findings while also acknowledging that there is significant work to be done in a number of areas.

In a statement, Chief Executive Nerissa Vaughan said: “The report shows the progress we have made during the busiest winter the NHS has ever seen, something the CQC have described as commendable.

“In addition to increasing the number of staff in our Emergency Department by 20 per cent since last autumn, we have recruited a further nine nurses and an additional senior matron.

“We’ve also started new safety checks for critically ill patients and have strengthened care plans to ensure that patients waiting longer than we would like, receive care similar to that which is normally provided on a hospital ward.

“At a time when we are seeing more than 230 emergency patients every day, our hard working teams have also improved our performance in admitting, transferring and discharging patients to just under the national four hour target.

“Our progress has not gone unnoticed, but there is still a long way to go and we will continue to focus on delivering the improvements needed.”