North West Ambulance Service And Aqua Partner To Improve Hospital Handover At Emergency Departments

Aqua are pleased to be partnering with North West Ambulance Service NHS Trust (NWAS) to try and improve hospital handover in emergency departments (EDs) and patient flow.

The national performance standard for ambulance handover at Emergency Departments (ED) is 15 minutes; it has been very difficult to achieve and sustain this in England due to capacity constraints within EDs and the acute hospital system.

The graph below shows the average arrival to handover times between April 2019 and January 2022 across the 30 North West ED’s.

The table below shows the arrival to handover position during 2021/22 and time lost to handover over 15 minutes.

Ambulance handover delays in ED’s can impact on both patients and services:

• Distress for patients
• Ambulance crews are not available to provide an immediate response to emergencies in the community
• The national AACE (2021) audit on patient harm shows that 8/10 patients whose ED handover was delayed for more than 60 minutes were assessed as having potentially experienced some level of harm. In NWAS 70% low harm, 18% moderate harm.

Improvement actions to reduce handover delays in ED

NWAS have introduced several successful initiatives in collaboration with acute NHS Trusts e.g.,

• NWAS refers the patient to local community services if they do not meet the criteria to be conveyed to an acute hospital. Community services are listed on NHS Service Finder and must respond within two hours.
• NWAS refers to hospital Same Day Emergency Care (SDEC) from the patient’s home if they meet agreed clinical criteria. On arriving on the hospital site, the patient bypasses the ED and goes straight to SDEC.
• Fit2Sit – if NWAS conveys a patient to ED who meets agreed clinical criteria, they will be booked in and will wait in the waiting room rather than on a trolley in an ED cubicle or corridor. Read the case study here.
• Handover Safety Checklist – this enables a succinct criteria-based NWAS clinician to hospital clinician handover. Read the case study here..
• Process improvement – this enables ED and NWAS to work together on joint areas of improvement to daily processes. Read the case study here.

Hospital Handovers

Despite these initiatives, patients are still waiting in the back of ambulances or ED corridors for many hours with the ambulance crew still present. To release the crews and meet the national 15-minute handover standard, NWAS and Aqua are working with all the acute trusts in the NW to introduce a handover escalation plan with clearly defined actions for NWAS and the trust, this incorporates the NWAS ambulance handover safety checklist. Supported by Gold Command or its equivalent in each county and by the CQC, the escalation action card was tested in GM hospital trusts in December 2021 and is adopted across the NW.

Adoption Roll Out Plan

To find out more about any of these initiatives to improve hospital handover and patient flow contact Manar.Aldean@nca.nhs.uk