Bronglais Hospital praised despite significant issues found

A new report from Healthcare Inspectorate Wales (HIW) highlights the professionalism of teams working in the emergency department (ED) at Bronglais Hospital during a period of significant operational strain.

The unannounced inspection, carried out over three days in July at the Hywel Dda University Health Board-managed site, found that despite challenges with patient flow and overcrowding, staff treated patients with respect and dignity.

However, the report also identified "significant issues" affecting the quality and safety of care.

Alun Jones, chief executive of Healthcare Inspectorate Wales, said: "Staff at Bronglais Hospital’s Emergency Department are clearly dedicated to providing safe and compassionate care despite very difficult circumstances.

"Our inspection highlighted areas of good practice but also identified significant issues with patient flow – challenges that are present across many emergency departments in Wales.

"We will continue to engage with Hywel Dda University Health Board to ensure improvement and progress against our findings."

Key areas for improvement identified by HIW included medication management, incomplete emergency equipment checks, delays in triage, overcrowding, and low compliance with hand hygiene standards.

The report also raised concerns about patients being treated in non-clinical areas such as corridors due to discharge delays, which compromised privacy and dignity.

HIW recommended that the health board improve patient flow and reduce reliance on non-clinical spaces.

The inspection found that paediatric areas were not consistently staffed with paediatric-trained nurses and were sometimes used to accommodate adult patients.

There was poor compliance with hand hygiene standards and no dedicated provision for cancer patients or those at increased risk of infection.

Other issues included incomplete patient assessments and inconsistencies in some patient records.

HIW advised the health board to improve documentation practices and consider introducing an electronic records system across the service.

Immediate concerns flagged by HIW included the condition and safety of emergency equipment.

Checks on paediatric and difficult airway trolleys were not always logged, safety signage was missing in the oxygen storage area, and medication fridge temperature records were incomplete.

Hywel Dda University Health Board took prompt action to address these concerns and has committed to ongoing monitoring.

Cathie Steele, interim assistant director of nursing, assurance and safeguarding at Hywel Dda University Health Board, said: "We take on board all the comments and recommendations made in the Healthcare Inspectorate Wales (HIW) report into Bronglais Hospital Emergency Department (ED).

"We immediately rectified issues identified for urgent improvement by the inspection to ensure the continued safety of patients."

Ms Steele said the health board had developed a full improvement plan, revised nurse staffing levels, and was in the process of recruiting an additional consultant.

She said: "We have recently revised our nurse staffing levels to enhance senior nursing support and oversight.

"The senior nurse role is crucial for ensuring that quality and safety audits are thoroughly completed, thereby maintaining high standards of care and senior support for the emergency and urgent care team.

"We are continuing our partnership work to improve flow through the health and social care system – our aim is that no patient in our care will be treated in corridors and non-clinical areas."

Staffing levels were described as generally acceptable, with minimal reliance on agency staff.

However, there was no ED matron in post at the time of the inspection.

HIW also noted limited consultant cover, particularly overnight and at weekends.

Despite the challenges, inspectors described the department’s culture as "positive and inclusive," with evidence of strong teamwork and a commitment to high-quality care.