Edinburgh's Royal Infirmary hospital patients left on 'urine soaked sheets' for hours in 'overcrowded' A&E

Edinburgh A&E had "extremely congested corridor areas with high numbers of patient trolleys"
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Patients lying on ‘urine soaked sheets’ and ‘blood stained pillows’ for hours have been uncovered in a report which has raised multiple safety concerns at Edinburgh’s Royal Infirmary.

Inspectors identified ‘systemic failures’ at the busy hospital including a fire safety risk created by overcrowding in the A&E department, which was found to have "extremely congested corridor areas with high numbers of patient trolleys". Staff described this as unsafe and a "fire safety risk". Findings of two unannounced HIS inspections of the Royal Infirmary of Edinburgh which covered 13 wards, intensive care and the emergency department took place in February when the hospital was ‘overloaded’ and operating amid peak, winter pressures.

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Following the inspection report published on Thursday, May 18, health chiefs admitted the hospital operating at more than capacity was ‘a common experience in recent months.’ Staff shift logs showed that, in the week before inspection, the busy emergency department was at times operating at more than 300 per cent of its capacity.

NHS Lothian has “sincerely apologised” to patients after the findingsNHS Lothian has “sincerely apologised” to patients after the findings
NHS Lothian has “sincerely apologised” to patients after the findings

In February health chiefs issued an apology to patients who were forced to wait for hours at Edinburgh Royal Infirmary’s A&E department as ambulances queued outside. Healthcare Improvement Scotland (HIS) said it was "not assured" of fire safety at the Royal Infirmary of Edinburgh A&E department and raised a number of serious concerns about patient care.

During one incident a patient was observed in a corridor area on sheets soaked with urine, while another had a blood-stained pillow for several hours before it was changed. One inspector had to intervene to stop someone falling off a trolley as they tried to push themselves over the rails to go to the toilet. Concerns were flagged about patients receiving the wrong medication.

The inspection report states a fire evacuation plan in place at the time "did not reflect the significant impact of overcrowding" and concluded, "we are not assured of fire safety within the emergency department". Staff reported having no space to move “in any direction” in both corridors and nursing stations. Senior managers confirmed that twice yearly fire evacuations which had been outlined in a fire evacuation plan “had not taken place due to the department being so busy”.

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NHS Lothian said a major improvement drive was under way following the report, which made a number of requirements for improvement and reform after identifying "multiple systemic failures" over two visits to the A&E. Bosses stressed inspectors visited the hospital following their busiest winter on record due to higher rates of Covid infection for patients and staff, staff absences and vacancies, and high numbers of patients whose discharge was delayed.

Lothian MSP Miles Briggs said: “These are very serious concerns in regards to overcrowding at Royal Infirmary of Edinburgh and the fire safety risk it creates. The A&E department at the hospital has been running over capacity for a number of years now, with SNP Ministers showing an inability to make any progress. Patient and staff safety must be the number one priority at the RIE and urgent improvements must be made.”

While Scottish Labour Health spokesperson Jackie Baillie said patients are being treated in unsafe conditions “with total disregard for their dignity and respect” whilst hardworking NHS staff are “at the end of their tether.”

Alison Macdonald, nurse director at NHS Lothian, said: “We accept and acknowledge the findings of the HIS report and we sincerely apologise to patients for longer than usual waiting times in the ED and a poorer experience of care. We had already begun our own improvement work when the inspectors carried out their first visit. When they returned for their follow up, it was clear to see that improvements had already been made, but more was required.

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"The “front door” of the hospital, which includes the Emergency Department, Acute Medical Unit and Minor Injuries Unit, is currently included in a system-wide review of capacity and a redesign of services, while discharge processes are being streamlined to reduce waiting times to help prevent overcrowding and increase capacity. We value and respect all of our teams and the hard work and dedication they bring. We are introducing new ways of working and reforming services to help better support our staff in their roles delivering patient care every day.