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. Others 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 local level. Now is the time for the NHS as a whole to move to a place of zero tolerance 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.
Whole system collaboration
Some areas have made great strides in tackling this issue at local level, and examples of this are highlighted in the report. Significant progress has been made in reducing handover delays in many areas, but NHS leaders from all parts of the service recognise more still needs to be done. Turnaround delays have a negative impact on the whole system as well as individual patients.
Turnaround delays are expensive. One ambulance deputy chief executive reports the loss of nearly 2000 hours of ambulance time at a cost of around £1million in one quarter.Turnaround is everyone’s problem – it impacts through the whole system, from primary care to acute trust – and everyone needs to play their part if a solution is to be found.
‘Zero tolerance’ approach
The NHS must work towards a culture of ‘zero tolerance’ to delays in ambulance turnaround.
In achieving change, leadership, collaboration, partnership and the sharing of understanding are key.
Equally important are common definitions of performance, shared terminology, agreed KPIs, penalties and incentives, and clear and agreed data capture.
In addressing the timeliness of patient handover there must be no compromise in the quality of patient handover.