The level Dr Gray’s Hospital is under-staffed and under pressure has been laid bare in a detailed inspection report.
Officials have made 20 requirements after making an unannounced visit to Moray’s biggest hospital.
They include ensuring patients are triaged timely, feedback to staff following worrying incidents is improved and personnel are fully aware fire evacuation procedures when patients are waiting in corridors.
Meanwhile, Healthcare Improvement Scotland has also called for improvements to the safe storage of medicine at Dr Gray’s.
It comes after “several” cupboards were found unlocked in accident and emergency with some medication missing.
NHS Grampian has praised staff for working through “unprecedented” pressures while an action plan has been agreed to drive improvements.
Dr Gray’s beyond capacity
Inspectors were told of “several incidents of overcrowding” with the Dr Gray’s accident and emergency during their visit in October last year.
At times up to five patients were being seen on beds in corridors at the same time with others in chairs. At one point the department was operating at 200% capacity.
One incident included a patient becoming “critically unwell” after waiting about 80 minutes to be triaged in A&E.
However, inspectors said reports of “significant” ambulance delays reported elsewhere in Scotland were not observed.
The emergency department at Dr Gray’s currently discharges, transfers or admits 67% of patients within four hours of arriving against a Scottish Government target of 95%. The national average is currently 65.9%.
Following the inspection, the Elgin hospital had a surge of patients during icy weather that doubled its daily average.
Professor Duff Bruce, clinical director at Dr Gray’s, described the pressure on the unit as “unprecedented”.
He said: “An astonishing 4,973 extra patients were seen in 2023, with a record 29,580 people requiring our urgent help and expertise.
“In spite of these demands our staff continue to do a remarkable job and to perform better than the Scottish average. That’s a testament to their hard work but it doesn’t mean we will be complacent.”
Inspection highlights high vacancy rate at Dr Gray’s Hospital
Attracting and retaining staff in Elgin has been a key challenge for NHS Grampian in recent years.
The Healthcare Improvement Scotland inspection report says it is a “significant concern” within the Dr Gray’s A&E department with staff voicing worries about numbers and skill mixes.
Figures published by inspectors reveal a reduction in the overall nursing vacancy level from 11.2% to 6.8% through 2023.
However, a 21.5% vacancy rate in the registered nursing level was considered to be more than double what officials considered “high”.
Long-term vacancies in the medical staff include a 71% vacancy level among consultants with a reliance on locums shared with Aberdeen and overtime.
NHS Grampian has launched a recruitment campaign for Dr Gray’s with a video promoting the region’s lifestyle targeted at major cities.
Hospital general manager Alasdair Pattinson said: “We are determined to get the teams the support they need and our recently launched, national recruitment campaign, which focuses specifically on Dr Gray’s, should help do just that.
“I’m pleased that it’s created such a buzz about the place and it should help us to go from strength to strength in the years ahead.”
Moray MP Douglas Ross said: “There are questions about A&E, how it’s run, and how staff communicate problems with senior management.
“One of those problems will be the impact of under-resourcing by the SNP government.
“We all know there aren’t enough nurses and that’s a sad reflection on nearly 17 years of inept workforce planning by the SNP.”
Missing medicine at the Elgin hospital
Specific improvements have been ordered by Healthcare Improvement Scotland to ensure medicines are stored securely.
Inspectors say “several” unlocked cabinets and fridges in A&E during their visit.
Delays in receiving new locks were blamed with work carried out immediately after inspectors raised it directly with hospital managers.
Records found “several” drugs unaccounted for with discrepancies in the management of controlled items.
Meanwhile, incoming shipments were seen at reception which had not been signed for on arrival from the pharmacy.
Poor record keeping with toilet flushing was also identified. The inspection came just months before hundreds of files were destroyed following a leak, believed to be caused by blocked plumbing from a toilet.
Moray MSP Richard Lochhead said: “People in Moray will be unsurprised to that Dr Gray’s staff have been praised for the compassionate and responsive care they provide.
“It’s vital that all public services work to continually improve and I welcome assurances from hospital management that feedback has been taken on board and plans are in place to address issues identified.”
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