Archived: Sunderland Eye Infirmary

Updated 20 January 2015

Sunderland Eye Infirmary is one of two acute hospitals forming City Hospitals Sunderland NHS Foundation Trust. City Hospitals Sunderland was established as an NHS trust in April 1994. Under the Health and Social Care (Community Health and Standards) Act 2003 the trust became an NHS foundation trust in July 2004. The trust provides acute hospital services to a population of around 350,000 people across the Tyne and Wear and Durham area. In total, the trust has 855 beds across two hospitals and employs around 4,923 staff. Sunderland Eye Infirmary has 22 beds.

We carried out this comprehensive inspection because the Care Quality Commission (CQC) placed City Hospitals Sunderland NHS Foundation Trust in risk band 2 in the CQC Intelligent Monitoring system.

Sunderland Eye Infirmary provides ophthalmology care and treatment in surgical, accident and emergency (A&E) and outpatient services for people living in the Tyne and Wear and Durham area.

The eye infirmary provides: a cataract treatment centre with a purpose-built twin theatre suite, providing day case surgery; an inpatient ward (Haygarth Ward) with separate areas for male and female patients and a dedicated children’s ward; and outpatient ophthalmology services in neighbouring hospitals and community facilities.

Additionally, the Eye Infirmary provides a seven-day ophthalmic accident and emergency (A&E) unit serving the north east. The A&E unit treats approximately 30,000 patients per year, who present with conditions ranging from minor irritations to major ocular trauma. Further outpatient clinics are held at South Tyneside, Durham and Hartlepool.

Ophthalmic outpatient clinics are held in several different areas on the site, each with a separate reception and waiting area.

Updated 20 January 2015

Sunderland Eye Infirmary is one of two acute hospitals forming City Hospitals Sunderland NHS Foundation Trust.

The trust provides acute hospital services to a population of around 350,000 people across the Tyne and Wear and Durham area. In total the trust has 855 beds across two hospitals and employs around 4,923 staff. Sunderland Eye Infirmary has 22 beds.

Sunderland Eye Infirmary provides ophthalmology care and treatment in surgical, accident and emergency (A&E) and outpatient services for people living in the Tyne, Wear and Durham area.

We inspected Sunderland Eye Infirmary as part of the comprehensive inspection of City Hospitals Sunderland NHS Foundation Trust, which includes this hospital and Sunderland Royal Hospital. We inspected Sunderland Eye Infirmary on 16 and 19 September 2014.

We carried out this comprehensive inspection because the Care Quality Commission (CQC) had placed City Hospitals Sunderland NHS Foundation Trust in risk band 2 in the CQC Intelligent Monitoring system.

Overall, we rated Sunderland Eye Infirmary as good. We rated it as good for being safe, effective, caring, responsive and well-led across each of the acute services they provide within the hospital.

Our key findings were as follows:

• Processes were in place to implement and monitor the use of evidence-based guidelines and standards to meet patients’ care needs.
• Patients were provided with care in a compassionate manner and treated with dignity and respect.
• Arrangements were in place to manage and monitor the prevention and control of infection, with a dedicated team to support staff and ensure policies and procedures were implemented. All areas we visited were clean. Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile) rates were within an acceptable range for the size of the trust.
• Patients were able to access suitable nutrition and hydration, including special diets. Patients reported that, on the whole, they were content with the quality and quantity of food.
• We had no concerns about staffing at this hospital. Staffing establishments and skill mix were maintained and regularly reviewed to maintain optimum staffing levels.
• We had no concerns about mortality rates at this hospital.
• The importance of patients’ and public views were recognised and mechanisms were in place to hear and act on patients’ feedback.

We saw an area of outstanding practice:

• The enhanced recovery pathway for cataract surgery and the role of the primary nurse were viewed as an excellent development of the service and resulted in individual surgeons’ cataract audits showing consistently higher visual acuity outcomes compared to benchmark standards (UK Cataract National Dataset audit).

However, we found that there was an area of poor practice that was a trust-wide issue resulting in a compliance action at trust level. This is reported in the trust provider report, which states:

The trust must:

• Ensure that patient group directions (PGDs), which are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment, are updated and monitored in line with trust policy

The trust should:

• Review the storage of medical records within this hospital.

• Develop mechanisms for reviewing and if necessary updating patient information, particularly in the outpatient department.
• Introduce patient surveys specific to the outpatient department.
• Review the participation in audits, including clinical audits in the A&E department.
• Review the arrangements for the role of the Eye Infirmary when dealing with major incident/events across the trust.
• Review the practice of recording patient concerns in the electronic nursing evaluation, in line with best practice guidance.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 20 January 2015

Overall, we rated outpatient services as good. Care and treatment received by patients in the Eye Infirmary outpatient department was effective, caring, responsive and well-led. Patients were happy with the care they received and found it to be caring and compassionate. However, some improvements were required with safety. Improvements were needed with the storage of medical records, and ensuring that patient group directions (PGDs) are updated and monitored appropriately.

Staff were well trained and supported and worked within nationally agreed guidance to ensure that patients received the most appropriate care and treatment for their conditions. Patients were protected from the risk of harm because policies were in place to make sure that any additional support needs were met. Staff were aware of these policies and how to follow them.

Some patient information leaflets in the department were past their review dates.

On the whole, the services offered were delivered in an innovative way to respond to patients’ needs and ensure that the department worked effectively and efficiently. For example, a third pre-clinic room was opened to help ease bottlenecks and improve the flow of patients.

Updated 20 January 2015

Effective arrangements were in place for reporting patient and staff incidents and allegations of abuse, which was in line with national guidance, and staff were encouraged to report incidents and lessons learnt from these were shared.

Staffing establishments and skill mix were regularly reviewed to maintain optimum staffing levels. Effective handovers took place between staff shift and included daily safety briefings to ensure continuity and safety of care.

Effective arrangements were in place to prevent and control infection and manage medicines.

Processes were in place to implement and monitor the use of evidence-based guidelines and standards to meet patients’ care needs. Surgical services participated in national clinical audits and reviews to improve patient outcomes.

Processes were in place to identify the learning needs of staff and opportunities for professional development.

The enhanced recovery pathway for cataract surgery and the role of the primary nurse were viewed as excellent developments of the service and resulted in consistently higher visual acuity outcomes compared with benchmark standards.

Patients spoke positively about staff, particularly the kind and caring interactions on the wards and between staff and patients.

Systems were in place to plan and deliver services to meet the needs of local people. Services were available to support patients, particularly those who lacked capacity to access the services they needed.

The trust’s vision, values and strategy had been cascaded to wards and departments, and staff had a clear understanding of what these involved. Staff were aware of their roles and responsibilities, and ward leadership was good.

The service recognised the importance of the views of patients and of the public, and mechanisms were in place to hear and act on patients’ feedback.

Updated 20 January 2015

We rated accident and emergency (A&E) as good. Systems were in place to ensure that incidents were investigated and lessons learned. There were enough staff to meet the needs of patients. Sufficient numbers of staff received mandatory training.

There were effective arrangements in place for the prevention and control of infection and areas observed were visibly clean.

However, we found that patient group directions (PGDs) were out of date. The chief pharmacist told us that this was flagged up on the risk register in January 2014 and should be resolved by December 2014.

The department used evidence-based guidelines in the management of eye emergencies. However, although clinical audits were carried out in the Sunderland Eye Infirmary (Eye Infirmary), there was little evidence of clinical audits being undertaken in the A&E department.

We found that staff received appraisals and were supported in their development. There was evidence of multidisciplinary team working with other departments and specialities in the Eye Infirmary, and with the main A&E department at Sunderland Royal Hospital.

Patients were provided with care in a compassionate manner and were given emotional support.

The department met the four-hour wait standard and did not breach the ambulance trolley wait standard. Access to translation and sign language interpretation services was provided. However, we were told that relatives sometimes translated clinical consultations with patients, at their request, which is not good practice. We were also told that when concerns were raised, these were entered into the patients’ electronic nursing evaluation.

We found that staff had a vision of the Eye Infirmary as a centre of excellence that they were proud of. There was a system of clinical and managerial leadership for the directorate of ophthalmology, in which A&E sits. We found that following a review of inappropriate referrals and misdiagnoses, a greater level of clinical leadership had been introduced into the department.