Ambulance Handover – a wicked problem or great opportunity ?

Ambulance 1

Hospital handover is an enduring and wicked problem in the NHS. Often the image of ambulances queuing outside Emergency Departments has become all too common place. The problem however is like many things in the NHS, complex, and there is no one solution. Ineffective handover can lead to wrong treatment, delays in medical diagnosis, life threatening adverse events, patient complaints, increased health care expenditure, increased hospital length of stay and a range of other effects that impact on the health system.

Understanding and managing increases in demand with targeted responses is important. Ambulance Services should complete the toolkits in Tackling Demand Together (DH 2009 - ) to support analysis of the reasons for increases in demand but we should also consider the human dimensions to achieving improvement, namely the ABCs:
  • Attitude
  • Behaviour
  • Culture
We are more likely to achieve sustainable quality improvement if we all develop and agree a way forward as a single team than if we create more rules and penalties, helping each other to help our patients.

Ambulance services should aim to reduce conveyance rates to type 1 emergency departments (through ‘hear and treat’, ‘see and treat’ or alternative pathways). A useful ambition is to improve urban conveyance rates to the same level as rural conveyance rates. Schemes that have been successful in reducing conveyance rates include:
  • Alternative care pathways to take patients directly to Urgent Care Centre/Walk-in centres;
  • Falls partnership vehicles with advanced practitioners;
  • Use of ambulances in alcohol ‘hot spots’ to provide a field vehicle to treat minor injuries at the scene;
  • Increasing the scope of paramedic practice to provide treatment without the need for conveyance;
  • Emergency care practitioners doing acute home visits on behalf of GPs to avoid admission and admission surge;
  • ‘Call back’ schemes for ambulance crews both in-hours and out of-hours to GPs;
  • High-volume service user planning in conjunction with GPs and acute Trusts
  • Direct referral to intermediate care/community rapid response
Increased bed occupancy in acute hospitals, lack of flow and public behaviour have all been cited as contributory factors but this masks some of the fundamental issues with effective handover. The NHS Emergency Care Improvement Programme (ECIP) has developed a series of workshops and educational materials to help local systems tackle the issue of handover and improve the care given to patients -

The workshop approach has been based on whole systems and draws together some practical recommendations and advice to improve hospital handover. This will be supported by a series of webinars and web based resources relating to ambulance services.

ECIP - Realising the Potential – “An improved approach to ambulance handover”

Join us for a webinar on Apr 04, 2016 at 12:30 PM BST.

Register now!

Ambulance handover delays at hospitals have become common place. This webinar considers the reasons why and offers solutions to help resolve the problem.

After registering, you will receive a confirmation email containing information about joining the webinar.

Author - Mark Ellis Intensive Support Manager /Ambulance Lead NHS Emergency Care Improvement Programme (ECIP).  [email protected]
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