"We are a resilient bunch" - QA Hospital staff reflect on the challenging first 100 days of the new A&E department

The Accident & Emergency department at Queen Alexandra Hospital in Cosham opened on November 26 last year. The opening coincided with winter flu season and a significant increase in patient numbers.

Staff have acknowledged “teething problems” as they get to grips with the new facility while under a lot of pressure. Portsmouth Hospitals University NHS trust, which runs QA, have put out multiple appeals to the public since December asking for its help to relieve pressure on the service, and also to treat staff respectably as tensions rise.

Vicky Donnelly, emergency department matron, acknowledged that staff morale has fluctuated. She said: “This is one of the strongest teams that I have ever worked with. Everywhere you go morale is up and down depending on time of day, situation, and stress. We are under a lot of pressure but we do our best to try and keep everyone's spirits high.

“We work alongside our colleagues making sure they are ok and are taking their breaks. Whilst not everything is always going to be amazing, everyone does their best to try and keep everyone's spirits high.”

The strength of the team was echoed by Kerry Gilbert who is also a matron in the department. She said: “We are a great team and are a resilient bunch. We have the highs and we have the lows but as a team we work really well together and that's what keeps us going through the difficult times.”

While there has been obvious challenges, both were excited to finally have moved in to the new department after years of planning. Vicky said: “In the beginning it was really exciting to be part of something iconic as we went through the whole build process together.

“We have had teething problems but I think you are going to have that everywhere you are. The biggest thing for us is we didn't realise the scale of the department. We wanted to come in earlier and do some mock run throughs of the department but we weren't able to do so. I think the team has done really well and we are still learning, still developing.”

One area was also flagged as a big improvement, allowing staff to manage infections better than they would have if they had remained in the old facility. Kerry said: “I think one part of the department which has made a difference is the major treatment area.

“They are in cubicles now so from a infection prevention perspective we are able to treat patients in cubicles. The layout of the department is also a lot more beneficial.”

Dr Peter Russell, clinical director of the emergency department, believes the new department has made a big difference : “This winter would have been vastly different in the old department. We have been able to get all the ambulances inside in a timely fashion, to prioritise the sickest patients and get senior decision makers in front of them as soon as possible.

“The environment we are working in is also far better for patients and staff. Our resuscitation room is double the size so we have been able to see our sickest patients much quicker than we used to be able to . The whole patient journey and staff experience in the new department is much improved.”

While accepting it has been a challenging time, Peter views the challenges faced as a common problem in all hospitals. He said: “It has been a difficult period, as winters always are in emergency department across the country, but it is a fantastic new department and it has had a lot of benefits for our patients.

“There is still a lot work to do, the department is often overcrowded. There is a lot through the patient journey from pre-hospital to discharge which can impact that overcrowding and it is something as an organisation that we are striving to get right.

One of the big areas to improve is ensuring patients are directed to the correct place for treatment. Peter said: “I think it is about identifying the patients that need the emergency department. A lot of people present to the emergency department with non-emergency problems. That overcrowds our ambulance and walk-in demand.

“We are working on different pathways to redirect patients and to make them aware, and indeed clinicians aware, of other pathways that don't involve the emergency department to reduce overcrowding.

“The other issue is getting discharges in a timely way, and social care to get patients out of the hospital. These are all works in progress and are problems faced nationally but we are doing are best to look at them and resolve them. They are wicked problems which are not easy to solve, otherwise we would have done it.”

With winter in the rear-view mirror, flu cases will reduce but there are still more challenges ahead. Peter said: “I would love to say we are coming out the other side but I don't think the other side is near for any emergency department.

“I think it is constant struggle of trying to get these pathways right and improve the flow of patients. There is not an easy fix otherwise we would have done it. We have a strong leadership team and resilient staff and we are going to do everything we can to make patients safe.”

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