Collaborative approach can make ambulance turnaround delays 'a thing of the past'

Published on Thursday, 06 December 2012 12:19
Posted by Vicki Mitchem

A collaborative whole-system approach could make delays in ambulance turnaround times a 'thing of the past', says a new report by the NHS Confederation.

Delays in handing over patients at emergency departments cause extended waits for treatment, are expensive and inefficient for the NHS, and can mean patients lack confidence in getting the right care in the right place when they need it. Around 80 per cent of ambulance handovers take place within 15 minutes, but the report calls for ambulance services, acute trusts, primary care providers and commissioners to work together in taking a 'zero tolerance' approach to the remaining 20 per cent.

The report, 'Zero Tolerance: Making ambulance handover delays a thing of the past', grew out of joint work between ambulance trusts, the acute sector, NHS commissioners and patient representatives, which scrutinised turnaround practice across the country.

The most valuable learning to emerge from that work has been distilled into ten recommendations, the first being that patient handover delays are seen as a whole system issue. Other recommendations include the need to develop shared definitions for describing, monitoring and recording processes, and for representatives of each part of the system to work together at local level to address patient handover issues in their area.

NHS Confederation interim director of policy Jo Webber said:

"The vast majority of patient handovers between ambulance crews and hospital staff take place within minutes, but with nearly 5 million emergency ambulance journeys each year, and nine out of ten of these resulting in patients transported to an emergency department, it is right that the whole service looks at ways it can improve in this area. There are some innovative and highly effective examples around the country, and there have been some great successes at a local level. Now is the time for the NHS as a whole to take a zero tolerance approach on this.

"Any delay in handing over a patient at an emergency department is not good for the patient, means a delay in getting that ambulance back out on the road to attend to another patient and that means an unnecessary cost for the NHS as a whole.

"But this is not a problem just for ambulance services and acute hospitals. Getting the right solutions in place is a job which needs input from all health and care service components, including commissioners and the primary care sector to work out what the issues are at local level and how they can be tackled effectively. Increased efficiency on turnarounds will benefit the whole service, but even more important is the benefit patients will experience. It's a win-win situation."

Health Minister Lord Howe said:

"Everyone should be seen quickly when they arrive at hospital, even more so when they arrive in an ambulance. It is unacceptable for patients to be left waiting in ambulances outside hospitals.

"We want hospitals, ambulance trusts and commissioners to look closely at this report and work together to reduce long delays getting patients into A&E.

"The NHS needs to ensure it has proper plans in place to deal with high demand and we are doing everything we can to support the service in treating patients as swiftly as it can."

The report recommends:

Patient handover delays should be seen as a jointly owned whole-system issue. Leaders from all parts of each local health economy should commit to work as partners to reduce delays in order to improve patient experience, care and safety.

Hospitals, ambulance services and clinical commissioning groups (CCGs) should each identify specific individuals who commit to work together – and with social services colleagues and other partners – to explore, understand and address the causes of handover delay in their area and the impact they have on patient experience, safety and costs.

Lead commissioners should actively seek support for a zero tolerance approach to handover delays in their health economy.

Ambulance services, hospitals and commissioners should adhere to agreed, explicit and well understood definitions for describing, recording and monitoring handover processes, including key performance indicators (KPI) start and stop times.

Ambulance services and acute trusts, with the support of commissioners, should develop common KPIs to support adherence to the national standard of 15 minutes for both arrival to handover and handover to crew clear targets.

Ambulance services and acute trusts, with the support of commissioners, should develop systems that capture data automatically and transparently against agreed definitions, including start and stop times.

Partners should work jointly on local process mapping exercises, involving acute, ambulance and commissioning staff at all levels to review current handover and discharge pathways, identify where efficiencies can be made, pinpoint how processes can be streamlined and suggest areas for development.

Acute trusts should model their maximum hourly ambulance attendance capacity in partnership with ambulance trusts.

Ambulance services and acute trusts, with the support of commissioners, should seek to develop common escalation plans and ensure that these function as well out of hours as they do in hours.

All regions should seek to develop and implement a regional capacity management system (where they have not already done so).

Source: ©NHS Confederation

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