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Improvements needed in A&E patient handovers
23/04/2009
Auditor General calls for more determined efforts by hospitals and the ambulance service
Accurate information required to measure the time it takes to hand over patients from ambulance crews to hospital A&E departments is not yet available and is preventing a robust picture of the problem being established, says a report published today, by the Auditor General.
It found that while there have been some positive steps to improving the handover process, the true extent to which delays occur is unclear. Handover times are not being consistently recorded due to problems with new data terminals, staff resistance in using them and uncertainty over the process of recording information.
Many patients have to wait far too long at hospitals before ambulance crews can transfer them into the care of hospital staff. That is poor care for the patients who are delayed as well as tying up ambulances that are needed elsewhere.
Long handover times can result in ambulances left queuing outside hospitals, patients awaiting medical attention on ambulance trolleys in hospital corridors and ambulances struggling to respond to new emergency calls. New targets introduced in 2008 gave ambulance crews and emergency units 15 minutes for patient handovers and have helped to raise awareness of the issue and consequences of excessive delays in the patient handover at hospitals and signal the Assembly Government's commitment to improving the situation.
Before the targets came in, handover times were not routinely measured and performance against the target is still unclear because of the problems embedding the new data collection system including acceptance of the need to measure handover times. The ambulance trust monitors turnaround times and has used an internal target of twenty minutes for the total turnaround (handing the patient over plus the time making the vehicle ready for the next call). The ambulance service has estimated that crews were delayed at hospital emergency departments for nearly 30,000 hours beyond this 20 minute target in 2008.
Handover delays often coincide with times of severe pressure in emergency departments and highlight poor matching of resources to peaks in demand.
The processes setting out how patient handovers should happen vary widely across Wales and the report found some examples of good practice which should be more widely spread. The report includes a self-assessment checklist that NHS trusts and the ambulance trust can use at each emergency department to assess the efficiency and effectiveness of the handover process.
The report, Unscheduled Care: Patient handovers at hospital emergency departments, makes a number of recommendations for improvement, to address the need for:
- NHS trusts and the ambulance trust to ensure the new handover data collection system can provide the necessary management information to identify and address the root causes of excessive delays.
- collaboration between NHS organisations to ensure there is the required leadership and vision to eliminate excessive handover times.
- NHS organisations to inspire greater staff commitment to data recording and prevent handover delays becoming an accepted part of the working culture.
Auditor General for Wales, Jeremy Colman, said today:
"The NHS in Wales needs to take a firmer grip on patient handover times. Excessive handover times at emergency departments affect capacity within the unscheduled care system because ambulance crews are consequently unavailable to take the next call. I hope the NHS will take on the recommendations outlined in my report, and that acute trusts and the ambulance trust will work together more effectively, to improve the situation."
Notes to Editors:
- This report considers whether the handover of patients by ambulance crews to hospital emergency departments is being managed efficiently whilst safeguarding patient care.
- It includes photographs taken by the review team during their unannounced spot checks. The photographs which highlight examples of delays to patient handovers and turnaround times. More photographs are available on the Wales Audit Office website http://www.wao.gov.uk/
- It is the first in a series of four Wales Audit Office reports which together look at the effectiveness of unscheduled care services in Wales.
- The Wales Audit Office is independent of government and is responsible for the annual audit of some £20 billion of annual public expenditure. Its mission is to promote improvement, so that people in Wales benefit from accountable, well-managed public services that offer the best possible value for money. It is also committed to identify and spreading good practice across the Welsh public sector.
- The Wales Audit Office was created in April 2005 through the Public Audit (Wales) Act, 2004, which expanded the functions of the Auditor General for Wales and enabled the transfer of staffs from the Audit Commission in Wales and National Audit Office in Wales to his employment.