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From YouTube: CQC Connect: Emergency departments responding to COVID 19 - Infection prevention and control
Description
In this episode of CQC Connect, the podcast from the Care Quality Commission, we look at emergency care through the lens of coronavirus, focusing on infection prevention and control (IPC).
We’ll talk about what the challenges have been; share learning and innovation; and hear from clinicians who have been on the front line.
Recorded in October 2020.
Listen to more podcasts from the CQC: https://soundcloud.com/carequalitycommission
Find out more information about the CQC and how it regulates health and social care in England: https://www.cqc.org.uk/
A
Welcome
to
cqc
connect
my
name's
ted
baker,
I'm
chief
inspector
of
hospitals
at
the
care
quality
commission.
Here
at
the
cqc,
we've
been
engaging
regularly
with
a
group
of
senior
clinical
emergency
department
staff
from
hospitals
across
the
country
to
understand
the
pressures
that
they've
they've
faced
over
the
covet
pandemic.
A
The
group
has
shared
the
steps
they
have
been
taken.
They've
been
taken
to
manage
the
infection
risk.
I
had
to
adapt
to
the
social
distancing,
real
rules
and
to
ensure
the
best
possible
care
is
provided
to
patients
under
these
difficult
circumstances,
as
well
as
speaking
to
some
of
the
group
as
part
of
this
podcast
podcast,
we've
also
been
working
with
them
to
help
develop
an
online
resource
called
patient.
A
First,
the
resource
aims
to
help
help
emergency
department,
staff,
hospital
trust
and
local
systems
to
build
on
the
positive
changes
brought
on
during
the
peak
of
the
pandemic.
I'd
encourage
you
to
take
a
look
at
it.
It's
on
it's
on
available
on
our
website
and
the
link
is
in
the
episodes
and
no
notes
for
this
podcast.
A
This
is
important
guidance
and
I'm
really
very
grateful
to
the
clinical
experts
who've.
Given
us
help
and
support
in
bringing
it-
and
we
hope,
you'll
find
it
useful-
this
episode
as
part
of
a
mini
series
looking
at
emergency
care
through
the
lens
of
the
coronavirus,
we'll
be
talking
about
what
challenges
there
be:
sharing,
learning
and
innovation
and
hearing
from
clinicians
who
are
working
on
the
front
line
about
how
they
are
tackling
the
issues
today,
we're
focusing
particularly
on
infection
prevention
and
control,
and
I'm
joined
by
two
members
of
our
national
emergency
special
advisors
forum.
C
A
Okay,
sally
james,
thank
you
very
much
for
joining
us
today
and
I
look
forward
to
a
stimulating
discussion.
Could
I
start
by
asking
you
to
tell
us
briefly
about
the
impact
of
coronavirus
in
your
area
of
work
and
what
what
have
been
your
biggest
challenges
or
concerns,
particularly
as
we
head
into
winter
james?
Do
you
want
to
lead
off
on
this.
B
I
think
there's
a
lot
of
fear
and
anxiety
that
was
brought
from
the
media,
the
public,
as
well
as
professional
anxiety
when
we
saw
the
health
systems
not
coping
in
other
countries.
Part
of
that
then
actually
led
to
a
huge
planning
mechanism.
I
suppose
in
the
organization
where
we
were
trying
to
plan
for
the
unknown
in
this
tsunami
that
was
about
to
hit
us,
there
was
the
the
sense
of.
Would
we
have
enough
ppe?
Would
we
be
able
to
maintain
safe
and
practices?
B
B
We
do
see
peaks
as
we
did
pre
covered
so
around
lunchtime
we're
seeing
them
in
the
afternoon
into
the
evening,
and
so
we
are,
we
are
looking
at
ways
of
managing
our
flow.
We've
created
different
pathways
in
order
to
manage
that
flow,
so
that
we
can
de-compress
the
departments,
but
we
are
still
challenged
when
we
do
see
surge
of
patients
arriving
at
the
front
door.
I
think
the
thing
that's
living
with
us
now
is
the
anxiety
of
the
second
wave
and
what
the
impact
of
the
second
wave
will
be.
B
Certainly,
london
was
the
epicenter
of
the
first
wave,
and
now
northern
regions
seem
to
be
the
epicenter
of
the
second
wave.
It
hasn't
quite
got
down
to
certainly
our
organization
at
the
moment,
and
so
so
we
are
really
I'm
starting
to
see
that
the
heat
maybe
turns
up,
should
we
say-
and
we
are
managing
to
keep
on
top
of
that.
But
it's
a
real
challenge
in
terms
of
keeping
our
capacity
free
to
move
people
through
and
not
have
people
crowding
in
ed.
We
are.
B
We
are
still
managing
to
be
fairly
successful
around
that
the
main
challenges
then
now
is
around
the
workforce,
mppe,
so
pp.
We
we
do
have
enough
ppe,
and
you
know
we
are
keeping
on
top
of
the
ppe
requirements,
but
certainly
it's
around
getting
fit
testing,
as
we
I'm
now
going
through
reusable
masks,
especially
for
the
emergency
floor
and
people
that
will
need
them
regularly
so
and
surround
the
fit
testing.
It's
also
around
people's
resilience.
B
And
should
anything
happen
to
them
that
actually,
you
know
they
dying
things
and
there's
the
the
elements
of
what's
been
psychological
injury
from
the
first
wave
and
things
that
people
didn't
see,
especially
younger
staff,
who
nearly
qualified
people
who
are
not
used
to
major
incidents.
They're
not
used
to
seeing
such
a
burden
put
on
them
on
a
daily
basis,
and
I
think
that's
been
the
sort
of
real
challenge.
From
my
experience.
C
We
are
a
five
site
hospital
trust
with
two:
a
e's
around
sort
of
a
50
mile
radius
and
and
the
challenges
that
we
found
was
actually
the
departments
were
really
difficult
to
actually
turn
into
kobe,
secure
isolation
areas,
particularly
the
hospital
round
at
barrow.
So
what
it's
meant
for
us
moving
forward
is
that
we've
looked
at
our
real
estate
and
we're
actually
doing
some
work
to
improve
the
actual
physical
layout
of
the
department.
So
that
was
a
challenge
for
us
I
think
moving
forward.
C
I
would
totally
agree
with
what
james
has
said,
but
moving
forward
for
us
at
the
moment.
The
challenge
that
we've
got
is
around
balancing
the
elective
work
that
we've
started
to
do
and
and
actually
need
to
do,
because
we've
been
seeing
some
quite
poorly
patients
come
through
the
door
that
have
maybe
had
treatment,
delayed
for
various
reasons
and
that's
balances
in
having
the
need
to
actually
look
and
review
our
surge
plans,
which
we
are
doing
now.
But
when
do
we
actually
push
that
button?
A
Okay
thanks.
Thank
you.
Sorry.
There
are
a
lot
of
challenges
there
that
all
units
across
the
country
will
be
facing
some
some
will
some
will
be
relatively
localized
to
their
unit,
but
a
lot
of
them
are
general
and
I
think
the
importance
of
the
patient
first
document
is.
It
has
guidance
on
many
of
those
challenges
brought
together
from
across
the
country.
So
again,
I'd
say
to
our
listeners.
A
Do
have
a
look
at
that,
because
many
of
those
challenges
will
be
addressed
in
there,
not
that
there
are
simple
solutions,
but
at
least
you'll
know
that
you're
sharing
the
the
best
solutions
that
that
our
clinical
experts
can
provide
we're.
Focusing
today
on
infectious
control,
though
that's
the
purpose
of
this
podcast.
So
can
I
come
back
to
you
sally
and
say
and
ask
what
do
you
think
a
trust
needs
to
do
to
ensure
effective
infection
control
in
the
emergency
department
in
this
winter
during
the
covered
pandemic?.
C
Salary,
thank
you.
I
think
the
most
important
thing
is
to
absolutely
maintain
that
close
working
relationship
with
the
infection,
prevention
teams
and
the
staff
that
have
got
that
specialist
knowledge
advice
and
actually
listening
to
them
and
then
using
our
emergency
department,
skills
and
knowledge
how
the
department
works,
the
flow,
etc
and
actually
turning
them
into
reality.
C
I
think
it's
about
empowering
the
staff
to
be
able
to
challenge
people
and
when
they
come
into
the
department
and
actually
control
the
entry
into
the
department
helps
reduce
the
risk.
I
think
it's
really
important
that
we
have
risk
assessments
and
the
risk
assessments.
It's
not
just
job
done.
If,
if
the
box
is
ticked,
it's
actually
people
understand
what
the
risk
assessment
means
to
them.
C
Their
team
members
and
actually
the
patients
are
looking
after
and
also
that
multidisciplinary
aspect
of
it
that
the
ambulance
service,
the
radiology
teams
that
may
come
into
rainey,
actually
understand
what
they
need
to
do
to
keep
themselves
and
all
of
us.
Safe
signage,
I
think,
is
absolutely
vital
and
we
talk
about
signages
on
the
door
on
the
floor
and
in
the
sky,
and
they
need
to
be
clear.
They
need
to
be
corporate
and
you
don't
need
too
many
of
them.
B
Yeah,
I
doubt
a
lot
what
sally
said.
I
think,
in
addition
to
that,
I
think,
there's
a
couple
of
things
in
terms
of
from
my
experience
is
plantar.
Plantar
walk,
I
would
say
so
actually
get
your
assessments
done.
Get
your
planning
done
talk
to
staff
operationalize.
It
plan
again
to
see
that
you're
still
going
the
right
direction
and
talk
again.
I
think
key
relationships.
B
You've
got
to
have
your
key
relationships
with
medical
awards,
I'm
fortunate
by
I'm
head
of
nursing
for
medicine
as
well,
so
I'm
able
to
influence
that,
but
I
think
for
areas
where
amy
is
just
sided
within
within
amy
as
a
specialism
on
its
own
you've
got
to
have
the
networks
in
order
to
to
be
able
to
move
people
on
in
a
timely
way
and
understand.
What's
going
on,
I
think
the
other
thing
just
picking
up
on
one
thing,
sally
said
around
general
infections.
B
I
know
we're
constantly
concentration
or
coded
at
the
moment,
but,
for
example,
if
you
end
up
with
a
norovirus
outbreak
or
an
outbreak
of
something
that
actually
is
equally
as
catastrophic
to
flow
and
catastrophic
to
the
operational
efficiency,
you've
lost
it
completely.
In
terms
of
trying
to
deal
with
covis
and
then
flu,
and
then
something
like
norovirus
as
well
and
certainly
in
winter-
and
we
all
know
that
you
know
you
get
the
flu
to
get
the
noroviruses,
and
so
I
think
people
have
got
to
be
vigilant
around
other
infections
as
well.
B
It's
not
getting
around
covered
because
we've
got
too
many
other
balls
in
the
air
at
the
moment.
So
we
don't
trip
over
health
systems.
I
think
also
it's
talking
to
your
commissioners
and
understanding
that
your
commissioners
understand
what
pressures
you're
under
and
vice
versa,
and
so
that
they
can
help
put
mechanisms
in
place
to
help
support
things,
especially
what
we
want
to
avoid
during
at
this
time,
especially
from
the
infection
point
of
view
is
having
to
go
on
diverse,
because
apartments
have
has
been
overwhelmed
from
from.
C
So
I
think
that's
really
important
and
also,
if
possible,
to
try
and
have
an
area
as
an
overflow
area
and,
like
james
says,
think
ahead
that
that
area
won't
necessarily
be
used
all
the
time,
but
it's
in
the
bag
there
ready
to
use.
Should
you
need
to-
and
I
think
that's
where
a
e
are
very
good
at
being
flexible
and
because
every
day,
like
you
say
it's
not
just
covered,
is
it
we
get
challenged
by
lots
of
different
things?
And
I
think
one
thing
we
are
good
at
as
as
clinicians
is
actually
being
flexible.
A
B
I
think
the
the
other
thing
is
staff
in
terms
of
class
fatigue
and
stuff
and
resilience
being
lower
resistance
to
change
and
resistance
to
being
able
to
manage
that
change
or
manage
ancient
horses
midstream,
so
to
speak
in
terms
of
getting
that
done.
I
think
also.
Some
of
the
other
barriers
is,
if
you
haven't,
got
effective
infection
controlling.
B
So
you
haven't,
got
effective
relationships
with
the
rest
of
the
organization
or
the
organization
itself,
don't
own
the
front
door
issues,
then
then
that
is
certainly
where
the
barriers
will
be
certainly
departments.
In
my
experience
that
end
up
with
corridor
weights
and
weights
of
ambulances
outside
struggle
with
getting
buy-in
from
the
rest
of
the
organization
or
the
rest
of
the
healthcare
system,
that
is
one
of
the
key
things
even
pre-coded.
B
Potentially
his
initially
was
an
issue
and
may
well
be
an
issue
going
forward,
and
then
I
think
that
there's
something
around
we're
all
trying
to
keep
us
the
elective
work
going
and
the
elective
pathways
going,
because
we
we
are
seeing
people
becoming
more
dependent
when
they
come
in
because
of
not
being
able
to
access
care
during
the
first
wave
of
provide.
I
think
part
of
the
problem
there
is
organizations
will
need
to
take
a
view
about
what
activity
can
continue
to
safely
go
and
what
activity
you
will
have
to
stop.
B
B
During
the
peak
of
covert,
because
predominantly
the
patient's
going
to
guys
our
shield
information
or
what
we
know
is
shielded
patients,
so
oncology,
renal
and
those
sorts
of
patients.
So
we
are
looking
at
very
two
very
different
models
on
our
different
sites,
saying
sunday's
doing
management
and
ultimately,
I
think,
there's
something
around
working
as
a
health
system.
A
Between
the
emergency
department
and
the
rest
of
the
system
within
the
hospital
and
outside
it
and
how
important
that
is
so
many
things,
I
think
he
said
that
james
it
was
important
anyway,
but
of
course,
infection
control
makes
even
more
important,
and
that
really-
and
if
people
look
at
our
patient
first
document,
they
will
see
that
it
aimed
not
just
as
emergency
departments
but
in
the
system
that
supports
emergency
departments.
Any
support,
there's
some
common
ownership
for
for
the
problems
emergency
departments
are
facing
going
into
winter
sally
anything.
You
want
to
add
on
barriers.
C
I
think
for
us,
obviously,
the
picture
around
covid
or
any
infection
moves
very
quickly
and
the
guidance
that
you
may
be
giving
out
and
asking
people
to
avoid
to
could
change
on
a
daily
basis,
which
you
know
in
the
beginning.
I
actually
did
and
that
I
think,
is
a
risk
and
a
risk
that
you
know
is
potentially
there
for
us
again.
C
I
think
the
only
way
to
try
and
mitigate
that
risk
is
to
try
and
embold
those
people
to
make
sure
that
they
comply,
because
the
people
on
the
floor
are
the
people
that
are
doing
that
every
day
and
while
we
may
have
the
documents
and
the
guidance
that
comes
in
from
all
our
different
organizations,
which
are
there
to
help
us.
It's
about
us
supporting
those
those
hands-on
operational
staff
to
actually
apply
that
guidance
to
keep
themselves
safe.
And
I
think
the
appetite
is
there.
A
B
That's
one
thing
I
think
really
is
important
barriers,
especially
people
being
tired
and
omissions
or
lapses
in
care
is
around
guidance
coming
out
and
changes
of
guidance
that
sally
just
brought
up.
I
think
what
we
experienced
the
first
time.
Certainly
the
schools
have
said
that
they're
experiencing
now
we're
getting
people
back
to
school.
Is
the
guidance
comes
out
that
fast
and
furious
with
more,
we
know,
and
it's
about
the
timeliness
of
implementing
that
guidance.
C
Yeah,
I
think
as
well.
I
think
we
have
to
think
about
the
messages
that
we
share.
If,
if,
for
whatever
reasons,
there
are
lapses
in
care?
Is
that
that
we
actually
make
sure
that
people
learn
not
just
for
those
people
that
have
been
involved
in
in
that
care,
but
actually
for
us
as
senior
leaders
that
we
actually
make
sure
that
those
lessons
are
shared
right
across
the
organization?
Because
actually,
if
there
are
breaches
to
do
with
infection
prevention,
they
may
be
happening
in
other
areas
of
the
hospital
as
well.
A
Yeah
one
of
the
one
of
the
really
good
things
I've
seen
coming
out
of
covid
in
some
services
is
they've
developed
a
really
strong
learning
culture
around
the
bedside.
So
when,
when
things
go
wrong
as
they
they
do
in
any
busy
service
under
pressure,
then
there's
immediate
learning
about
how
to
prevent
those
problems
occurring.
Of
course,
that
would
apply
in
a
busy
emergency
department
under
pressure
and
would
apply
to
inflation
control.
So
I
think
that
kind
of
bedside
learning
culture
is
absolutely
vital
to
doing
this
well
sally.
C
C
Somebody
to
take
that
gives
that
sense
of
ownership,
for
both
people
and
team
spirit
as
well.
For
us,
certainly,
some
of
the
pathways
that
we
have
within
the
organization
are
much
more
robust
now
and
and
have
continued
to
do
be
so,
and
we
also
had
a
what
we
call
the
red
hub
with
our
gps,
which
was
where
any
suspected
covered
patient
that
was
well
enough
to
go
to.
There
was
set
up
separately
and
that
helped
to
keep
the
flow
through
the
department
and
then
just
little
things
like
stickers
on
uniforms.
C
You've
got
an
ipad
for
patients
to
use
if
they
want
to
communicate
with
their
family,
obviously
cleaning
it
in
between
etc,
and,
most
importantly,
like
we've-
both
alluded
to
is
about
learning
lessons,
not
just
from
things
that
go
wrong,
but
from
good
practice
as
well,
and
we've
really
tried
to
keep
that
positive
slant
on
it,
particularly
when
the
times
are
really
difficult.
Early
on.
B
Yeah,
so
I
think
we
we
with
some
of
the
things
we
we've
done,
which
are
working
really
well:
we've
created
a
multi-specialty
assessment
unit,
so
actually
we
took
the
concept
of
our
ambulatory
medicine
and
our
cdo
pathway
and
we're
fortunate
that
they
were.
They
were
co-located
next
door
to
each
other
and
we've
actually
opened
it
up
as
a
multi-specialty
area.
So
what
we
do
now
is
when
patients
are
ready
to
be
seen
by
a
specialty
or
we
want
the
specialist
opinion
we
move
them
through
into
that
space.
B
This
is
a
30
30
spaced
area.
We've
also
created
some
waiting
space
in
there
with
partitions,
so
people
can
actually
sit
next
to
each
other
with
partitions,
so
we've
managed
to
maximize
our
waiting
space
and
if
patients
are
bound
or
admissions,
they
go
straight
to
the
ward.
So
we're
not
delaying
care
there
right.
It
does
decompress
ed
quite
effectively,
we've
also
split
our
say,
urgent
care
pathways.
So
we've
now
got
gps
in
one
area
of
the
hospital,
and
we've
now
got
minor
injuries
in
another.
B
So
it's
sort
of
going
back
to
the
old
days,
but
actually
it's
helping
decompress
things
and
also
we
we
are
able
to
manage
flow
better
and
that
way
by
giving
appointments.
And
that
way.
We've
also
redesigned
our
front
door
assessment
process.
So
we've
actually
now
got
a
when
you
walk
into
the
department
and
we
always
had
a
nurse
meeting
at
the
front
door
to
do
a
one-minute
assessment.
C
I
was
just
agreeing
with
a
lot
of
the
things
that
james
has
said
and
I
think
those
relationships
moving
forward
are
actually
going
absolutely
going
to
get
us
through
winter
and
whatever
the
next
few
weeks
and
months
will
bring
be
covered
or
any
other
infection,
and
certainly
people
that
we
we
knew
by
name.
We
now
know
by
face
which
I
think
is
really
nice
and
again.
People
are
continuing
to
think
different
ways
and
I've
been
able
to
improve
the
service.
B
Can
I
come
back
on
one
thing
that
I
suppose
I'm
painting
a
very
rosy
picture
of
how
the
relationships
all
working
together?
I
think
the
culture
that
you
have
to
adopt,
though,
is
also
a
culture
where
people
can
respectfully
disagree
with
each
other
as
well
and
respectfully
respectfully
put
forward
a
different
view
of
how
to
do
things.
I'm
going
back
to
my
earlier
points
about
keeping
an
open
mind.
B
We
have
to
be
able
to
professionally
challenge
each
other
when,
when
we're
not
necessarily
agreeing
with
the
direction
of
travel,
I
think
that
is
the
key
to
a
really
successful
pathway
organization
is
because
people
respectfully
disagree
and
then
respect
each
other's
views
around
that
it's
not
all
about
being
released
in
the
garden
one
one's
one
constituent
of
the
patient
pathway
having
dominance
over
another.
It's
got
to
be
collegiate
working.
C
B
B
We've
got
ourselves
in
the
patient's
shoes
and
actually
advocate
for
what
the
patients
need
and
that's
whether
you're
working
in
eds,
whether
you're
working
in
gynecologist,
whether
you're
working
in
mental
health,
we've
got
to
make
sure
we
are
the
patients
here,
especially
some
of
those
patients
will
go
on
and
become
independent,
we'll
go
on
and
become
really
debilitated
by
these
people
by
by
the
situation
they're
going
through,
and
actually
we've
got
to
look
ourselves
in
the
mirror.
At
the
end
of
this
and
say
we
did
right
by
the
patients.
A
Absolutely
and
I
think
the
fact
that
the
patients
don't
have
someone
with
them,
you
know
just
change
the
dynamic
quite
significantly
and
I
think
that
you're
in
sound
to
that
really
is
important
james.
So
thanks
can
I
just
ask
you
for
just
one
top
tip
about
infection
control.
So
if
there's
one
thing
you
you
wanted
to
say
to
your
colleagues
around
infectious
control,
what
would
that
be
sally?
John
lead
off.
C
Why
we're
doing
what
we're
doing
why
we
are
dressed
like
we
are,
what
they
need
to
do
to
keep
themselves
safe
and
then
communicating
that
to
each
other
within
the
department
and
across
the
organisation,
and
that,
for
me,
I
think
is-
is
the
most
important
thing
about
that,
because
those
patients
are
very
scared
and
seeing
us
all
dressed
up
in
all
our
gear
is
even
more
scary.
Having
to
wear
a
mask,
you
know
for
longer
than
just
doing
the
shopping
is,
is
is
quite
alien
to
a
lot
of
people.
C
B
The
first
necessary
100
the
first
time
around
and
actually
keep
an
open
mind
plug
the
document
in
terms
of
read
the
documents
and
then
buy
and
overlay
that
to
your
own
department
and
current
guidance
around
that,
because
not
everything
we
say
in
the
documents
will
one
size
doesn't
fit
all,
but
actually
one
size
can
be
tailored
to
what
you
need
to
do.
So,
for
example,
you
know
the
front
door
assessment
process.
I
know
a
couple
of
other
organizations
that
have
taken
the
principles
of
what
we've
done
and
I've
implemented.
A
I've
taken
enough
of
your
time.
You've
got
busy
jobs
working
on
the
front
line.
So
thank
you
for
your
input.
I
haven't
really.
I
can't
bring
your
experience
on
I'm
working
in
eds
to
to
to
produce
a
tip
for
for
our
colleagues
who
are
listening,
but
my
tip
would
be
read
patient
first,
please
do
share
it
with
people
who
you
work
with
both
within
your
department,
but
also
in
the
other
parts
of
the
system
that
provide
support
to
you.
It's
not
new
guidance.
It's
not
more
guidance.
It
is.