Coronavirus: London’s Nightingale hospital recorded 144 safety incidents in 29 days

The field hospital in East London treated 54 patients in total

London’s Nightingale hospital recorded 144 patient safety incidents during its 29 days treating 54 patients, it has emerged.

There were two serious incidents at the field hospital, a doctor told a Royal Society of Medicine webinar.

Dr Andrew Wragg, consultant cardiologist and director of quality and safety at Barts Health NHS Trust, said a study of the long-term outcomes of the 54 patients was ongoing, as 20 of those treated at the ExCel conference centre site were still recovering in hospitals across London.

The Nightingale was built to house up to 4,000 Covid-19 patients. It opened in April to cope with a predicted surge in patients needing critical care to help them breathe after the virus attacked their lungs and caused pneumonia.

Although more than 2,000 staff volunteered and trained to work at the hospital, only 700 staff were actually employed on shifts there as the hospital never had more than 35 patients at any one time.

Johanna Cade, a nurse at Guy’s and St Thomas’ NHS trust and who worked at the Nightingale, said: “We had quite high incident reporting at 144 incidents reported and I think that demonstrates that Nightingale really did well at building a no blame safety culture for resolution and learning. This system manifested itself and staff were really striving to make things better continually. We knew who to report to and how to escalate things.”

She showed data revealing the largest number of safety incidents involved medical devices.

There were 25 incidents that included the ventilators used to keep patients alive. Staffing issues and medication, as well as pressure ulcer and communication incidents, were also among the highest numbers.

She said the vast majority of incidents led to no harm of the patient, or only low harm, with only a few categorised as causing moderate harm.

In one example, she described how a patient’s blood sugar levels were misread on the paper notes used by the bedside staff in the first week of the hospital being open. She said this was investigated and led to changes in the way blood sugar was monitored and information reported.

There are more than two million safety incidents reported across the NHS every year – but during the period the Nightingale was open it reported more incidents than any of the other hospitals run by the Barts Health Trust.

Dr Wragg told the webinar: “Our very high levels of incident reporting are kind of a good evidence of that strong safety culture.

“We were safe. It was both personally and professionally, an incredible experience working there, mainly because of the amazing staff and colleagues who were very much focused on the responsibilities of what we had to do and deliver.

“We also recognised from day one that we just had to be a learning hospital. We were not a hospital to begin with, we had not tested any of our systems and processes. We really didn’t know whether we were going to be able to deliver a reasonable set of outcomes and that really meant whether our patients would have acceptable mortality from being looked after at our hospital, and we just had to learn very quickly.

“If there was a safety concern raised on the Monday, often by the Tuesday we would have the learning required around the issue fed into the training of new staff coming on board.

“You may argue that 54 [patients] doesn’t sound that many, but actually in conventional ICU terms that was still a significant ICU, and that was still a significant amount of critically ill patients that we cared for.”

Barts Health NHS Trust said: “The safety of patients is our absolute priority and all staff are encouraged to report all incidents – no matter how small – to prevent repetition. Of the incidents raised at the London Nightingale, no severe harm was caused to any patients.”