The Association of Ambulance Chief Executives (AACE) has published a report following a structured clinical review of handover delays at hospital emergency departments across England.
This reveals for the first time the extent of potential harm that is being caused to patients when they must wait in the back of ambulances or in corridors before they are accepted into the care of their local hospital.
The review found that the proportion of patients who could be experiencing unacceptable levels of preventable harm is significant. Over eight in ten of those whose ‘handover’ (from ambulance clinician to hospital clinician) was delayed beyond 60 minutes were assessed as having potentially experienced some level of harm; 53% low harm, 23% moderate harm and 9% (one patient in ten) could have been said to have experienced severe harm.
The impact assessment was coordinated by AACE and was undertaken in all ten English NHS ambulance services who reviewed a sample of cases from one single day in January 2021, where handovers exceeded one hour.
Experienced clinicians assessed the range and severity of potential harm experienced by those patients who were already seriously ill, frail or elderly and who waited for sixty minutes or more before being accepted into the care of the hospital from the ambulance crews in attendance.
The nationally defined target for hospitals included in the NHS Standard Contract states that all handovers between ambulance and A&E must take place within 15 minutes, with none waiting more than 30 minutes.
Since April 2018, an average of 190,000 handovers have missed this target every month (accounting for around half of all handovers) while in September 2021 over 208,000 exceeded the 15-minute target.
Responding to the latest report ‘Delayed hospital handovers: Impact assessment of patient harm’ published yesterday by the Association of Ambulance Chief Executives, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “This report makes for stark reading but will come as no surprise to Emergency Department staff.
“Patients should never be delayed in the backs of ambulances. Patient safety is being compromised. When there is simultaneously no space in the Emergency Department and ambulances queuing outside the Emergency Department, we are no longer delivering effective urgent and emergency care to the community.
“We support our paramedic colleagues and will continue to work with them to tackle these handover delays and keep patients safe. But these pressures must not be addressed in isolation. The answer does not lie with the ambulance services nor in the Emergency Department. This is a system-wide problem that requires system-wide action and solutions. In particular, the answer is not just to increase physical space in the Emergency department with no additional staff.
“Trusts and Boards must focus on increasing flow throughout the hospital to reduce exit block and ensure patients are moved through the system. In the immediate term, Trusts and Boards must safely expand capacity throughout the hospital where possible to stop patients being delayed in ambulances. Social care must be resourced to ensure patients can be discharged when they have completed their treatment to prevent long hospital stays.
“We entered the pandemic with too few beds in the system and have continually struggled to manage with reduced capacity, now this is unsustainable. It is vital that the government restore bed capacity to pre-pandemic levels to achieve a desirable ratio of emergency admissions to beds. Currently 7,170 beds are required across UK Trusts and Boards.
“Patient safety is at risk and without urgent action avoidable harm will continue to fall upon patients while urgent and emergency care will fall deeper into crisis.”