Hospital handover delays root cause of ambulance woes
DELAYS in transferring patients from ambulances into hospitals are putting their safety and dignity at risk, inspectors have warned.
Healthcare Inspectorate Wales (HIW) has today published a new report looking specifically at handover delays between the Welsh Ambulance Service and hospital A&E departments and how they are affecting patient care.
Between April 2020 and March 2021 there were approximately 185,000 ambulance handovers to emergency departments throughout Wales. However, less than half of them (79,500) occurred within the target time of 15 minutes.
During that period there were also 32,699 incidents where handover delays were in excess of 60 minutes, with almost half (16,405) involving patients over the age of 65 who are more likely to be vulnerable and at risk of unnecessary harm.
Data published by the Welsh Government highlighted that in December 2020 alone, a total of 11,542 hours were lost by the ambulance service due to handover delays. This figure has been rising sharply and has now reached prepandemic levels once again.
Inspectors said these delays have consistently led to multiple ambulances waiting outside A&E departments for excessive amounts of time, unable to respond to emergencies.
“These delays have serious implications on the ability of the service to provide timely responses to patients requiring urgent and lifethreatening care,” the report stated.
“We found handover delays impact on the ability of ambulance crew to provide a positive experience for patients. It may also increase the risk to patient safety through delays in diagnosis and receiving treatment, as well as to the risk to people awaiting an ambulance in the community, with fewer ambulances available to respond to their needs.”
HIW said that patient handover delays are not directly a problem with the Welsh Ambulance Service, but are a consequence of “wider systemic patient flow issues” throughout NHS healthcare systems and social care services.
“Concerns were also highlighted to us of severe overcrowding within emergency departments which leads to the inability to offload patients from ambulances,” the report added.
Inspectors found that a minority of A&E workers and ambulance crews were unfamiliar with handover policies.
The report added: “We found day-to-day inconsistencies within the same department and sometimes between clinicians and ED staff, as well as a lack of clarity between the Welsh Ambulance Service and ED staff about responsibility for a patient until transfer to the ED.
“These types of inconsistencies can introduce risk and have a detrimental impact on patient care and safety and therefore requires attention.”
A survey by HIW found that 71% of ambulance crews who responded stated that they did not feel emergency department staff and the service provided by ambulance crews worked together to provide seamless patient treatment and care.
During 2020-21, the Welsh Ambulance Service recruited more than 100 additional frontline staff. However, inspectors said it was “concerning” to find that in response to its survey, only 31% of ambulance workers said there were adequate staff for them to do their job properly.
Despite the handover problems, HIW said patients were generally positive about their experiences of ambulance staff, particularly in relation to their kindness, communication and management of situations.
In response to the report Claire Roche, the Welsh Ambulance Service’s executive director of quality and nursing, said: “Ambulance crews know better than anyone the impact that delayed handover has on a patient’s experience because they spend many hours – sometimes an entire shift – with the same patient on the back of a vehicle.
“It’s as distressing for our crews as it is for the patient and their loved ones. Our emergency ambulance service exists to deliver lifesaving immediate care and to take patients promptly to hospital for the necessary treatment.
“For the Welsh Ambulance Service, this is about getting to the root of the issue in order to resolve it, rather than adapting to a situation so that it becomes the new normal.”