Reducing ambulance handover delays

Delays in patient care

Ambulance services across the country are under an immense amount of pressure due to the current ambulance handover crisis and systemic issues within the NHS. 

Although the media is no longer reporting on rising COVID-19 cases, this hasn’t stopped emergency calls from increasing, with many ambulance services still under the same level of pressure as during the height of the pandemic.

Key statistics are showing queues of up to 11 hours at certain hospitals, leading to a dramatic increase in the wait time for an ambulance when patients call 999 as well. The detrimental effect on patients is clear to see. Not only is this a waste of ambulance resources, but it delays patient care on the frontline and runs the risk of deterioration in patients at home in need of urgent care.

From hospital capacity to patient flow to bed occupancy, there are multiple issues at play here, all with their own intricate solutions.

Handover delays are not simply an ambulance service issue, however, but a systemic problem throughout the healthcare service. From hospital capacity to patient flow to bed occupancy, there are multiple issues at play here, all with their own intricate solutions.

Can we reduce hospital handover delays and, ultimately, eliminate them?

“Handover delays are not an ambulance issue, they are a whole-system issue impacted by challenges elsewhere in the system, particularly with hospital capacity and patient flow. This includes delayed discharges to social care and other services, as well as bed occupancy. As such, a whole-system approach is needed to tackle them.” – NHS Confederation.

How can we help reduce ambulance handover?

NHS Trusts across the country are actively working to reduce ambulance handover times. The NHS has implemented an improvement guide, outlining key lines of enquiry, to allow Trusts to review their ambulance handover process and identify issues to be addressed.

What the NHS is currently doing to help

  • Escalation process, where time to ambulance handover exceeds or is likely to exceed 30 mins and a regional level escalation process for 60 mins or more
  • Ambulance staff are able to access facilities such as toilets and refreshments
  • Patients are not to be held in ambulances outside the hospital
  • Fit2Sit – assessing the patient’s ability at every stage
  • Patients are referred to the appropriate assessment units, rather than to the Emergency Department (ED), unless in need of resuscitation

But ambulance handover is predominantly about patient flow throughout the rest of the hospital. Where are the patients going when they’re admitted?

What bottlenecks are happening within the ED that are preventing more patients from accessing the service – for example, patients in trolleys in corridors? 

Ambulance Receiving Centres

Increasing space and capacity within ED by utilising Modern Methods of Construction (MMC) solutions, such as modular ambulance drop-off centres, would enable ambulance services to quickly alleviate patients waiting on ambulances, and ultimately provide hospitals with more space to assess patients.

With modular constructions, critical facilities such as hand washing and toilets for ambulance staff can be included. Hospital and ED operations are less likely to be disrupted with a separate Ambulance Receiving Centre.

Of course, this doesn’t entirely solve the problem of patient flow throughout the rest of the hospital, but if we look at certain Trusts as examples of the other tactics they’re implementing, this can be a robust solution.

What are Trusts currently doing to tackle ambulance handovers?

The London Ambulance Service (LAS) has currently invested in four new emergency vehicles, with specially trained volunteers who work alongside the LAS. They’re known as volunteer emergency responders. Although this is an extreme scenario, it’s one way that the NHS and individual services are tackling the current ambulance handover crisis head-on. 

As we’ve seen by the LAS example, individual Trusts are handling the ambulance handover issue with gumption, but clear guidance needs to be implemented nationwide, as well as alternative, better solutions.

Trusts that are outlining a whole-system approach to reducing ambulance waiting times are decreasing delays and solving other systemic issues. An example is Leeds Teaching Hospital Trust and the Yorkshire Ambulance Service. Their process incorporates a dedicated ambulance team, who take responsibility for the patient as soon as they arrive on-site, with an ambulance drop-off centre and an escalation process where additional space can be created for patients.

But it’s not just enough for a few Trusts to innovate and escalate this issue. What more can be done?

How can MMC help?

The Royal College of Emergency Medicine president-elect, Dr Adrian Boyle, told BBC’s Newsnight: “We can’t just open up into a corridor in an emergency department where there isn’t space. The corridors in emergencies are frequently full anyway. 

“What’s better is if we can discharge patients from hospital, create that space so we unblock our emergency departments and allow ambulances to hand over their patients seamlessly.”

With a modular building, this seamless handover can occur. The rapid response MMC can bring in relation to pre-constructed modular buildings (our ambulance receiving centres as an example) is truly impressive and can help to address the growing ambulance handover delays quickly.

Systemic change

In a recent article by NHS Providers, a call was made for the whole health and care system to work as one to tackle the root causes of handover delays for patients coming to hospital by ambulance. Clearly a whole system approach is required:

“Handover delays are often viewed as a problem relating to the interface between ambulance services and hospitals. They are, in fact, a symptom of much wider pressures, including the ongoing delays in discharging medically fit patients from hospital. At the end of April, 62% of the 20,155 patients who were medically fit to be discharged, remained in hospital. Due to stretched and underfunded services in domiciliary and intermediary care, and a lack of social care provision, patients cannot be discharged safely. And so the pressure grows.

“Hospitals are struggling to deal with rising urgent and emergency care demand while making crucial progress on reducing the care backlog.” – NHS Providers.

 “There are other capacity constraints contributing to the delays. Hospitals are struggling to deal with rising urgent and emergency care demand while making crucial progress on reducing the care backlog. Mental health services are also under incredible strain, with latest data showing that 1.6 million people are in contact with secondary care services. Some may still be waiting to be seen. The number of children and young people in this position is almost three times higher than when records began.”

Although the problem of ambulance handover delays won’t disappear overnight, potential solutions are clearly outlined – collaborative solutions at Trust level and system wide measures including helping people to stay well and intervening early to prevent crises.

With an emphasis on preventing problems before they happen, strategies are being put in place to help ease the pressures across the system that ultimately contribute to handover delays.

Innovative solutions

With systemic change at the forefront of most NHS Trusts’ minds, implementing innovative and quick solutions initially is also vital to keeping their Emergency Departments and hospitals from collapsing. 

Modular ambulance receiving and drop-off centres can provide a beacon of hope for ambulance services, ED teams, and patients. 

Book an ambulance handover centre demonstration with the Health Spaces team today to see the bespoke solutions we have available for your facility.

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