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:
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: