15 November 2021

Thousands of patients at risk of harm while ambulances queue outside hospitals

15 November 2021

Emergency care in the NHS is under “unprecedented strain”, experts have warned, after a new report showed that tens of thousands of patients in England may have come to harm while waiting in ambulance queues outside busy hospitals.

Up to 160,000 may have come to harm, including 12,000 who could have suffered serious harm, according to analysis by the Association of Ambulance Chief Executives (AACE).

The AACE studied all handover delays lasting more than an hour that occurred across the 10 ambulance trusts on January 4 – a “usual day” in activity levels.

It used the data to estimate how many patients a year suffered as a result.

“If the numbers of people potentially harmed by handovers on this date were extrapolated across all handover delays that occur every other day of the year, the cases of potential harm could be at least as high as 160,000 patients affected annually,” the association said.

“Of those, at least approximately 12,000 patients could experience severe harm because of delayed handovers.”

National guidance states that paramedics should be able to hand patients over to A&E staff within 15 minutes of arriving at hospital.

But the AACE said that since April 2018, an average of 190,000 handovers have missed this target every month, accounting for around half of all handovers.

In October, NHS leaders stepped in and ordered hospital bosses to “eliminate” ambulance queues outside hospitals.

Delays in the transfer of care from ambulance to hospital clinicians remains a significant and growing problem

NHS bosses in England wrote to trust leaders highlighting the “risk to patient safety” after two deaths were linked to handover delays.

An investigation was launched in October after a patient died at Worcestershire Royal Hospital following a five-hour wait in an ambulance at the doors of the emergency department.

And it was also reported that a woman died in the back of an ambulance following a handover delay at Addenbrooke’s Hospital in Cambridgeshire.

Hospitals were told to end all handover delays and stop using ambulances as emergency department “cubicles”.

Martin Flaherty, managing director at AACE, said: “Despite ongoing efforts over the years to reduce delays in handovers and mitigate potential harm to patients, and a welcome renewed national focus on the problem from NHS England and Improvement, delays in the transfer of care from ambulance to hospital clinicians remains a significant and growing problem.

“We are clear that the problem is a symptom of system pressures and will require a whole-system approach to resolve it once and for all.

“While some health systems have been able to make noticeable improvements in respect of handover processes, the challenge persists for others, and we continue to see a rise in both the number of patients affected and the length of these delays.

“The causes of these delays are multifactorial and reflect the pressures in local health systems, as well as the availability of health and social care packages, which greatly impacts on patient flow.”

Commenting on the report, Dr Nick Scriven, past president of the Society for Acute Medicine, said: “Urgent and emergency care is under unprecedented strain and there is no hope of resolving the wider NHS system problems – like cutting waiting lists and capacity issues – until this is sorted out, as it goes hand in hand.

“What we are now seeing are more cracks appearing in what was already a very weak NHS infrastructure, so we need to see a clear focus from NHS leaders on ensuring adequate staffing, facilities and initiatives to help alleviate pressures.”

The answer does not lie with the ambulance services nor in the emergency department - this is a system-wide problem

Meanwhile, the Royal College of Emergency Medicine (RCEM) called for “system-wide action” to tackle the issue.

Dr Katherine Henderson, president of the college, said: “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.”

A spokesperson for the NHS in England said: “Staff have gone above and beyond over the last year treating hundreds of thousands of seriously ill Covid patients in hospital and most recent data shows record levels of A&E attendances and the highest ever number of 999 calls and life-threatening ambulance call-outs in a single month.

“NHS services are working collaboratively – including with AACE’s members – in line with actions set out for systems to prevent ambulance handover delays with immediate effect, so the public should continue to come forward through the appropriate route so staff can help you with the best option for your care.”

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