In addition, on 05 February we returned and carried out a focused unannounced inspection of the Emergency and Assessment Unit EAU and took enforcement action, on 26 March we returned to ensure that systems were in place to protect people from avoidable harm. Overall, we have found that the ratings and provision of care in each core service varied greatly. The trust was a caring organisation throughout, and staff we observed in the majority were passionate about their work and caring towards patients.
We found that the burns service was providing excellent care, with some of the best outcomes for patients with severe burns in the country, and the results were competitive with burns centres worldwide. Generally, we found the critical care and services for children and young people good, with improvements needed in medical care, surgery, end of life care and outpatient and diagnostic services.
We found examples of poor care and practice in urgent and emergency services which we have rated as inadequate, and also in maternity and gynaecology and specialist burns and plastic services which required improvement. During our inspection of Broomfield Hospital EAU on 5 February we found that the safety of the emergency assessment unit EAU was inadequate but this did not impact on the rating for urgent and emergency services which was already rated as inadequate.
However the rating for leadership within urgent and emergency services changed from requires improvement in November to inadequate. This is because the leadership of the unit did not act to ensure that appropriate and registered staff were responsible for the direct care of patients on the EAU.
The leadership of the service failed to act on concerns raised by staff and the senior management team failed to have effective governance and assurances processes in place to monitor the work and roles of the staff working in adaptation posts whilst they were awaiting registration. Overall, we have rated Broomfield Hospital as a requires improvement service as whilst there are two inadequate ratings for the safe domain this only relates to one core service.
We have identified areas where improvements are required. It was evident that throughout the organisation staff were passionate, dedicated and cared about the work they delivered.
The service has had an unstable few years with management changes and this had impacted on service flows, confidence and stability. The service is on a journey to improving the services provided and this will take some time to embed throughout. There were significant staffing shortages particularly for qualified nurses throughout the hospital but there was a plan in place to recruit over additional nurses, though it is recognised by the trust that skill mix would remain a challenge for some time.
The emergency department like all throughout England in November was under pressure from a high volume of attendances. The flow of the emergency department, staff vacancy, skill mix and triage did have an impact on the care patients received which in some cases was poor. The care of patients with mental health concerns fell below the expected standard of care.
There was no clear pathway or plan for patients who were receiving care at the end of their life. The development and implementation of this plan was required following the removal of the Liverpool Care Pathway in The trauma service within plastic surgery particularly on Mayflower was disorganised and impacted directly on patient care and safety when the ward became overcrowded with patients.
Significant concerns were raised around Writtle ward and their high use of non-trust staff and case mix of medical outliers and women with gynaecological and early stage pregnancy concerns. There were significant waiting lists in place for patients who require a follow up outpatient appointment over 24, at the time of inspection across all specialties.
There was no risk assessment process in place for those patients to ensure that a longer wait was acceptable. Governance structures at departmental level across the emergency department, medical care, specialist plastic surgery, maternity and gynaecology and end of life care were not robust and were in significant need of improvement. The Burns service was outstanding and there innovative developments and plans the service had.
We commend them for the work that they are undertaking and their achievements to date. The caring and responsive approach shown by the chaplaincy and the services provided to bereaved families by staff in the mortuary were outstanding.
Staff within both services went beyond the call of duty to support families, particularly those bereaved of children and babies. The burns service was outstanding with innovative and pioneering approaches to care delivery and outcomes for people with burns which had been reflected in national research papers. Outcomes for patients with serious burns was comparable among the best in the world and were consistently exceptional. Pathways for breast reconstruction and hand therapy were outstanding.
The mortuary team were innovative and passionate about providing a good patient experience at the end of life. Individual specialist staff in the trust including the learning disability nurse, specialist nurse for dementia care and the manual handling advisor were identified as being outstanding and highly responsive to patient and staff needs.
The nurse-led peripherally inserted central catheters PICC was developed within the critical care service without initial funding, it has seen great success and improved patient outcomes.
There were outstanding examples of local leadership and innovation in the intensive care unit. However, there were also areas of poor practice where the trust needs to make improvements.
Ensure that only registered nurses are included in the nursing numbers and ensure that staffing numbers are maintained on the EAU by suitably qualified and registered staff.
Ensure that incidents are appropriately reported and investigated on the EAU. Ensure that the adaptation staff working in the hospital are provided with support, supervision and competency training as well as mentor support. Improve governance and assurance processes around the use of adaption staff throughout the hospital to ensure that they work within the scope of their role.
Immediately improve inpatient deterioration recognition across all inpatient areas, particularly on Writtle Ward. Immediately work to reduce the number of patients who are on a waiting list for a follow-up outpatient appointment. Reduce the number of hospital-acquired pressure ulcers. Ensure care documentation, including care plans and risk assessments, are undertaken in a timely way, accurately, are fully completed, and reviewed when required. Ensure that nursing handovers are robust and identify patients at risk.
Improve treatment times for patients with prostate cancer to ensure a higher percentage of patients receive their required treatment within 62 days. Improve governance systems to include formalised and minuted mortality and morbidity meetings across the directorates. Ensure that systems for providing staff with feedback on incidents, and sharing learning from incidents, are embedded throughout the trust.
Develop a strategy for the improvement and delivery of end of life care. Improve staff training and awareness on mental health, so that the provision and care for patients in urgent and emergency services with mental health conditions improves.
Ensure patients with mental health concerns are risk assessed on arrival at the emergency department. Ensure that patients are referred to in a dignified and respectful way, and not as bed numbers, particularly on Danbury Ward. Ensure all items of equipment that require annual service and maintenance are maintained on time.
Ensure patient prescription charts for medicines are signed when medicines are administered, particularly in the emergency department and emergency assessment unit. Ensure medicines cupboards are kept secure at all times. Ensure that intravenous IV fluids are stored securely to minimise the risk of tampering. Ensure that all safeguard referrals for adults in the emergency department are completed and actioned in a timely way.
Work to improve safety, and reduce incidents with a serious impact, on the labour ward. Reduce the number of elective surgeries, including elective caesarean cancellations. Improve hand washing techniques, and infection control practices and techniques, in the emergency department, emergency assessment unit and on Writtle Ward. Ensure that only clinically appropriate patients are admitted to Writtle Ward, also ensuring that the medical outliers criteria for Writtle Ward is not breached.
Review the decision to lift the birth cap on the maternity service, and determine a safe way to manage the increase in the number of women attending in labour. Improve the standard of 'do not attempt cardio-pulmonary resuscitation' DNA CPR forms completion throughout the trust.
Implement an approved end of life care plan and pathway for patients. Review the pathology referral system to ensure that all referrals are managed safely.
Review the need for a dedicated link co-ordinator for the health team at HMP Chelmsford, to co-ordinate prisoner visits. Improve governance arrangements and quality assurance, particularly in incident reporting, risk registers and incident investigations.
Ensure quality dashboard data is consistent across the directorate and is in a format that is easily accessible to patients and relatives. Provide day rooms for care of the elderly wards. Decrease the number of agency and bank staff by improving recruitment and retention of nursing staff. This would improve access to training. Work and balance staff skill mix across areas to ensure skilled experienced staff are on duty where possible.
Improve the incident reporting culture for staff trust wide to increase the number of incidents reported overall. Review staffing and management structures for end of life care. Ensure that recruitment plans, to increase the amount of permanent burns nurses, are agreed and actioned to ensure that the high usage of agency and bank staff is reduced.
Ensure that there is a paediatric trained registered nurse, consultant and anaesthetist available at all times within the Burns service. Review Burns specific policies and procedures to ensure that there is evidence of regular review and ratification.
Improve patient confidentiality throughout the wards particularly when staff are discussing patient care. Ensure that cardiac monitor alarms are not muted without ensuring that patient is safe. Ensure that patients with mental health concerns are appropriately observed and monitored. Improve patient care within the emergency department around sepsis and head injuries in line with Royal College of Emergency Medicine guidelines.
Improve local staff engagement throughout all services within the hospital. Safely work to reduce the number of emergency caesareans performed in maternity. Consider reviewing the case mix on Danbury ward to ensure those receiving oncology and end of life care are with an appropriate patient group.
Consider reviewing nursing shift lengths to minimise the number of Improve audit and evidence based care and treatment in maternity services. Provide formal team meetings in the maternity and gynaecology wards for staff. Review cultural concerns and alleged bullying culture by management within the maternity service.
Improve week maximum referral to treatment RTT waiting standards for general surgery and trauma and orthopaedics. Review executive and non-executive leadership arrangements for end of life care to drive the end of life care agenda through the trust. Improve the incident reporting culture trust-wide.
Develop a maternity specific trigger list to ensure robust reporting measures. Improve the culture and leadership on EAU. Improve the incident reporting culture relating to safe staffing levels. The Care Quality Commission has also issued the trust with a warning notice in relation to care and welfare concerns identified for patients receiving care at Broomfield Hospital.
These can be viewed in the enforcement section of this report. The trust provides services from five sites in and around Chelmsford, Maldon and Braintree.
Broomfield Hospital is an acute bedded hospital which has an additional 18 contingency beds not inclusive of obstetrics. We inspected this hospital on 19 August in response to concerns of stakeholders and information of concern received into the CQC.
Concerns around the assessment and treatment of care provided to people with mental health conditions were also shared with us prior to our inspection. This was a responsive review undertaken by five inspectors from CQC and two specialist advisors. We were also supported by an Expert by Experience. We have identified that the service was not compliant with some regulations following this inspection.
We have not rated the service as this was a focused inspection however a further comprehensive inspection will be undertaken in November to determine ratings of all services within the trust.
In addition, we sought the views of a range partners and stakeholders. The inspection team make an evidenced judgment on five domains to ascertain if services are:.
Safe Effective Caring Responsive Well-led. Whilst we noted some good practice there were also areas of poor practice where the trust needs to make improvements. Review the consultant rota to ensure that the minimum numbers of consultants are scheduled on the rota in line with The College of Emergency Medicine guidance. Review the use of the room where mental health patients are placed for assessment.
Ensure that the emergency alarm in the additional majors bays sounds in the correct department. Improve governance processes and embed an open culture of reporting, sharing and learning from incidents and complaints to improve the care and experience provided to patients.
Increase attendance at safeguarding training for all staff and improve safeguarding awareness. Ensure that staff receive training to support patients with mental health needs. Improve numbers of staff attending conflict resolution training and provide breakaway training. Review working with the psychiatric liaison services, CAMHS and the local mental health trust to improve the care provided to patients within the department.
Improve multi-agency working with external agencies including the local ambulance trust and police force around mental health provision.
Ensure that all staff work together effectively to enhance the experience of the patients, ensuring effective communication at all levels.
Ensure that risks are assessed and managed within the department. Hold meetings in the department to discuss incidents or other governance concerns to staff at all levels.
Take prompt action to ensure that staff speak to and refer to patients in a dignified and compassionate way. During this inspection we found that the essential standards of quality and safety were not being met in some areas. As a result of our findings we met with the Chief Executive and Chief Nurse of the Trust on 28 August to discuss our concerns. We were informed that the trust would address the concerns identified; we were also shown areas that were in the process of being improved since our visit.
Therefore we have issued the trust with compliance actions. We have asked the provider to send CQC a report that says what action they are going to take to meet these essential standards. We will follow up to ensure appropriate action to address the concerns has been taken in November On this occasion we did not speak with anyone who used the service about the way their medicines were managed.
People were protected against the risks associated with medicines because the provider had improved arrangements in place for the storage and recording of medicines. We found that Mid Essex Hospital Trust had taken steps to improve the patient assessment and record keeping and they now had more accurate and consistent records on which to base clinical and nursing management decisions.
However we still found areas for further improvement and the trust were aware that more work needed to be done, especially around person centred care management. People we spoke to on the wards we visited were happy with the care that they received.
One person told us: "I have drunk more water in here than I ever do at home" and another said: "I get fed up drinking all this water but I know its doing me good. We visited Broomfield Hospital in July We found that the trust was not compliant with Regulation 9 of the Health and Social Care Act Regulated Activities Regulations in that they were not accurately assessing peoples' needs and planning care to meet people's individual needs and ensure they were receiving the support they required.
We found that the trust remained non-compliant in that people still did not have accurate or timely assessments of their needs in place, the planning and delivery of care was not robust and did not always ensure the welfare and safety of the people using the service.
We also found that the trust was not adhering to recognised guidance issued by the appropriate professional and expert bodies. We spoke to people using the service. They told us that they were happy with the food provided and the choice available. Comments included "I get enough to eat", "The food here at Broomfield is very good" and "The food is much better than the last time I was in hospital.
However we found that people did not always have a prompt and accurate assessment of their actual or potential risk of malnutrition and dehydration. We found that the provider did not have proper arrangements in place for the safe storage and security of some medicines and the safe administration of medication. We did not speak to people using services on this occasion as this visit primarily focused upon record keeping.
Patients we spoke told us that they were satisfied with the care and treatment they received during their hospital stay. Patients on Felsted ward told us that staff were attentive and caring. I always get the help I need. The doctors and nurses are wonderful. I cannot fault the care here.
Two parents we spoke with told us that they felt confident that their children received the very best care. They really take into account our fears and keep us up to date with any changes in treatment. There is always someone available to speak with and answer any questions I have.
One patient commented that on occasions the treatment had not been explained to them initially by the doctor. They told us that when they asked the nursing staff that they were given a full explanation of the treatment. Patients on Danbury and Billericay wards told us that staff were polite, pleasant and helpful. They also told us that procedures were explained to them in a way that they could understand.
Some patients told us that staff gave advice in a calm and reassuring way and presented them with treatment options, making them feel included in decisions about their care. The majority of patients we spoke with told us that they were happy with the quality and choice of food available to them during their visit to Broomfield Hospital. One patient commented that, in their opinion, there were not enough vegetables served. Zone E, level 1 - lift lobby and level 2 - lift lobby. Zone B, south entrance, opposite lifts Zone A, level 1 central corridor - opposite the travel centre.
We have areas across the site that allow you to sit, rest and eat during your visit which are the wellbeing terrace, main entrance courtyard and at the end of the atrium. Please make sure you maintain social distancing during your time at our hospital and ensure you wear a face mask or face covering whilst on site. A face covering can be a face mask, a scarf or a bandana. There are 1, car parking spaces at the hospital, with 61 of these spaces reserved for disabled drivers.
Should you require any further information and guidance on the proposed car parking control measures, please e-mail us on: MSE. We have placed cookies on your computer to help make this website better. You can at any time read our cookie policy. Otherwise, we will assume that you're OK to continue. Update on roadworks near Broomfield Hospital Planned roadworks to replace the roundabout and traffic islands at the intersection of Main Road and Hospital Approach will now run until Monday 10 January, with disruption to traffic and delays expected, as follows: 7 to 22 December: restricted access via Hospital Approach with some traffic diverted via Court Road 6 to 10 January: night time lane closures 8pm to 5am with two-way traffic lights and all hospital and estate traffic diverted via Court Road Dates may be subject to change, so please always observe road side signage.
Coming to Broomfield Hospital - Planning your journey. How to find us Planning Your journey to Broomfield Hospital. By bus There is a bus stop outside the main hospital atrium entrance and there are numerous bus routes servicing the hospital from across the area and further afield across mid and south Essex. Covering Chelmsford with their wheelchair accessible minibuses - and across Essex in their volunteer cars Chelmsford Community Transport is a patient transport scheme provided by volunteers for patients and their families who have difficulty getting to and from their hospital appointment.
They offer: Minibuses free using your concessionary bus pass Door to door service Affordable prices Friendly DBS checked drivers Assisted trips available Small registration fee applies For more information on how to book go to the website www. By train Rail company Greater Anglia operates frequent trains to Chelmsford station where a bus can be caught direct to Broomfield Hospital. When that share exceeds 20 percent, a hospital is said to be under extreme stress, and as the share approaches 50 percent the stress is said to be immense.
Below are the latest figures for hospitals in Broomfield, Jefferson and Adams Counties. Editor's note: This list was automatically generated using data compiled by the U.
The local hospitals included in the list are limited to those included in the government data. Please report any errors or other feedback to content patch. Local Data , Patch Staff. The figures are current through Thursday, Jan. Find out what's happening in Broomfield with free, real-time updates from Patch.
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