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Patient 'lay dead' in London A&E for 'hours' before being found Patient lay dead in London A&E for 'hours' before being found
(about 1 hour later)
A patient lay dead for up to four-and-a-half hours before being spotted at one of the busiest A&E departments in the country, inspectors have revealed.A patient lay dead for up to four-and-a-half hours before being spotted at one of the busiest A&E departments in the country, inspectors have revealed.
A review of North Middlesex University Hospital by the Care Quality Commission also found there were too few competent doctors who were able to assess and treat patients at night.A review of North Middlesex University Hospital by the Care Quality Commission also found there were too few competent doctors who were able to assess and treat patients at night.
Emergency services at the London hospital have been rated "inadequate".Emergency services at the London hospital have been rated "inadequate".
The hospital said it was "extremely sorry" for the problems in the unit.The hospital said it was "extremely sorry" for the problems in the unit.
Inspectors reviewed the department in April and May.Inspectors reviewed the department in April and May.
'Fear of retribution''Fear of retribution'
The unit - which sees 500 hundred patients a day - logged 22 serious incidents in the past year, including the dead patient not being found for hours. The unit - which sees 500 patients a day - logged 22 so-called "serious incidents" (SI) in the past year.
Others included a patient being left sitting on a bedpan for more than an hour and only one commode being available for more than 100 patients on one occasion. Inspectors were told about it as they were looking into whether nurses were able to conduct hourly rounds.
And nurse to patient ratios were rarely achieved because they frequently had 20 patients being treated in the corridor. "We were told one recent SI investigation concluded that a failure to take hourly rounds meant that a patient had lain dead for up to four-and-a-half hours before being found," the report said.
There were also issues regarding the nurse to patient ratios, which were rarely achieved. The ratio should be 1:4 but more recently it had been 1:10 with up to 20 patients being treated in the corridor.
There was also a delay with patients being transferred from trolleys to beds.
The aim, staff said, was to move patients "most at risk of developing pressure ulcers" within four hours but inspectors saw that in three cases patients were on hospital trolleys for between six and 13 hours and were moved only when senior staff had been notified.
Other issues included a patient being left sitting on a bedpan for more than an hour and only one commode being available for more than 100 patients.
The report also said staff were afraid to speak up for fear of retribution.The report also said staff were afraid to speak up for fear of retribution.
The inspection of the emergency department and two of the hospital's medical wards was in response to concerns about the standards of care.The inspection of the emergency department and two of the hospital's medical wards was in response to concerns about the standards of care.
The hospital has apologised to patients and says the A&E department now has five additional doctors and consultants on loan from other London trusts, a new nursing lead and new clinical director. The hospital has apologised to patients and said its A&E department now had five additional doctors and consultants on loan from other London trusts, a new nursing lead and new clinical director.
Chief Inspector of Hospitals Sir Mike Richards said the hospital has already "turned a corner" since the inspection. Chief Inspector of Hospitals, Sir Mike Richards, said the hospital had "turned a corner" since the inspection.
He said: "A new leadership team is in place in the emergency department, there are moves to appoint more senior doctors - and I note that the trust is calling on consultants from other departments within the hospital to provide the routine daily support to A and E which is so badly needed. He said: "A new leadership team is in place in the emergency department, there are moves to appoint more senior doctors - and I note that the trust is calling on consultants from other departments within the hospital to provide the routine daily support to A&E which is so badly needed.
"There is still much more that needs to be done. We will be watching their progress very closely.""There is still much more that needs to be done. We will be watching their progress very closely."
The report found:The report found:
David Burrowes, Conservative MP for Enfield Southgate, said he was left to wait for 12 hours on a trolley with a ruptured appendix in the emergency department in 2014. David Burrowes, Conservative MP for Enfield Southgate, said he was left to wait for hours on a trolley with a ruptured appendix in the emergency department in 2014.
He said "urgent action" was needed.
"The important question is why the warning signals from at least two years ago were not heeded," he added"The important question is why the warning signals from at least two years ago were not heeded," he added
Labour MP for Tottenham, David Lammy said the "damning" report is "even worse than I feared" and demanded answers from Health Secretary Jeremy Hunt. David Lammy, Labour MP for Tottenham, said the "damning" report was "even worse than I feared" and has demanded answers from Health Secretary Jeremy Hunt.
He said: "It shocks and appals me that this situation has been left for so long without an intervention from the Health Secretary, and the way that this has been covered up is nothing short of a scandal."He said: "It shocks and appals me that this situation has been left for so long without an intervention from the Health Secretary, and the way that this has been covered up is nothing short of a scandal."
During the same inspection, medical care services were rated as requiring improvement.During the same inspection, medical care services were rated as requiring improvement.
The trust is now required to improve the care of patients in the emergency department by 26 August 2016 following a warning from the CQC.The trust is now required to improve the care of patients in the emergency department by 26 August 2016 following a warning from the CQC.
A full inspection of the trust will take place in September.A full inspection of the trust will take place in September.