A health watchdog has ordered an inquiry into the deaths of 54 patients over six months at a West Midlands hospital accident and emergency department.
The Russells Hall Hospital in Dudley is being probed after concerns were raised about its A&E death records as part of an inspection in June.
Now an independent inquiry has been ordered after a Care Quality Commission (CQC) report rated the hospital’s emergency care as “inadequate.”
The inquiry will be carried out by Mike Bewick, the former deputy chief executive of NHS England, to establish why the patients died in the emergency department.
The CQC said investigating deaths is outside of its remit, but it is taking enforcement action against the 852-bed hospital for its failings.
A spokesperson said: “The CQC has raised concerns about deaths at Russells Hall Hospital and, following our June inspection and discussion with partner agencies, an independent review has been commissioned to look into a number of deaths.
“The review of deaths falls outside CQC’s remit. However, we continue to monitor the trust very closely and have taken enforcement action.”
Dudley Group NHS Trust, which runs the hospital, said it had the region’s lowest mortality rate.
Diane Wake, chief executive of the Dudley Group trust, said an initial draft report suggested many of the patients had been dead on arrival and there was no national data to determine how many deaths there should be in an emergency department.
Responding to the June inspection report, Wake said the trust had recently appointed a new clinical lead for urgent and emergency care.
She added that the trust had “approached a neighbouring trust” whose A&E was rated “good”, so that “best practice” could be shared between consultants.
During the inspection four staff told the CQC they would not want relatives to be treated there over fears they “may deteriorate or die”.
Inspectors saw three patients in reception who “appeared very unwell” and members of the public raised concerns for the safety of two of them.
One of the three was bleeding profusely until inspectors intervened and asked for them to be treated due to concerns for their immediate safety.
The watchdog also found care records were not always accurate and complete and said A&E patients did not always receive a “robust assessment of their clinical presentation and condition during the triage process”.
Concerns were also raised that some patients with suspected sepsis were not identified or managed appropriately and that there was “a disconnect” between leaders’ impression of sepsis management in the department and what was happening in practice.
The report added: “Doctors appeared frustrated at the focus on sepsis and did not fully engage with the need to assess for sepsis.”
Sepsis is a serious life-threatening condition which can arise from unrelated infections and kills almost one in five people in the UK who get it.
As a result of its inspection, CQC took action to vary conditions on the trust’s registration.
Heidi Smoult, deputy chief inspector of hospitals in the Central region, said: “We have had ongoing concerns about the emergency department at Russells Hall Hospital and were extremely concerned at what we found during our inspection.
“Patients were not being consistently assessed in a safe way, in particular, whether staff were identifying patients with suspected sepsis effectively.
“As a result of this we have varied conditions on the trust’s registration meaning it must provide regular updates to CQC surrounding staffing, triage of patients and its management of sepsis.”
Smoult said inspectors returned to the department last month to carry out a further inspection and a full report will be published in due course.
She added: “We have also continued to escalate our ongoing concerns with partner organisations and to work with NHS Improvement to ensure that necessary steps are taken to improve safety for patients.
“The trust knows what it must do to ensure people receive the care they should be able to expect and we will return to check on whether sufficient improvements have been made.”