Healthcare Improvement Scotland (HIS) said that, while some progress had been made by Victoria Hospital in Kirkcaldy since their last visit in May, they had identified several areas where urgent improvement was still needed.
The previous inspection flagged up significant concerns over the hospital’s management of beds at busy periods.
Following another unannounced inspection at the end of last year, HIS said there had been improvements in the way NHS Fife managed patient capacity issues.
But the organisation said it remained concerned about patients with cognitive impairment – such as memory loss – being moved from one ward to another to help deal with capacity issues.
This practice – known as boarding – has been criticised by doctors who believe this can lead to worse outcomes for patients.
The report highlighted changes made to deal with a surge in patients, including opening up a new ward as needed and additional staff brought in.
But HIS said improvements in this area should continue to be implemented.
Their report said that decisions by doctors and nurses that a patient should not be moved could be overridden by those in charge of managing beds.
“Moving patients can increase their level of confusion and lengthen their stay in hospital,” the inspectors said. “Although we are assured there have been improvements in the way NHS Fife manages patient capacity and flow, we remain concerned about patients with cognitive impairment being boarded for non-clinical reasons.”
There was also criticism in the report that staff were not properly dealing with documentation on decisions not to attempt to resuscitate patients – so-called “do not attempt cardiopulmonary resuscitation”.
Where appropriate, such decisions should be discussed with the patient and their families so they are aware of the patient’s condition.
Further improvements were also needed in how patients were monitored for malnutrition and nutritional needs, the report added.
Overall, inspectors identified one area of strength in the hospital’s care of older people and 11 areas for improvement.
Jacqui Macrae, head of quality of care at HIS, said NHS Fife had to address the areas for improvement “as a matter of priority”.
“We also saw examples of positive, caring and friendly interactions between staff and patients, with the majority speaking highly of the care they received,” she said.
“However, we identified several areas where NHS Fife must improve the care provided to older people.”
Heather Knox, NHS Fife director of acute services, said: “We are pleased to note that the inspectors recognise the significant improvements. The introduction of new systems and processes, including the Discharge Hub, has further improved patient safety.”