The majority of ambulances arriving at the Lister’s emergency now have their patients handover and ambulances ready to return to duty within 30 minutes of arriving. A new system, which was trialled in March 2017 and has been running since shows that the national turnaround standard is being achieved for over 80% of ambulances – which is the best performance in the East of England. Previously the Lister service saw between 10 to 15% of ambulances meet the standard.
When an ambulance arrives at A&E, there are two national standards that are expected to be met – the hospital team has 15-minutes in which to complete handover of the patient from the ambulance crew, who in turn have a further 15 minutes to get their vehicle ready to be deployed again.
The Trust’s matron for the Lister’s emergency department, Kate Masterson, explains:
“With the help of colleagues in the Trust and the local ambulance service, we set about redesigning the handover process. The same steps are followed, but the sequence and how they are carried out has been changed to eliminate inefficiencies and wasted time. Trials were undertaken of the new process at the start of March, which showed very positive results and the system went live from 20 March 2017. Overnight, the Trust went from being pretty much the worst performer in the region to being the best. From 10% of ambulances being turned around within the overall 30-minute window, the new handover system saw that figure rise to 80% – where it has stayed ever since (and in some weeks, the team delivered the best performance in the country).”
Dave Fountain, deputy director of service delivery at the East of England Ambulance Service NHS Trust, added:
“We have worked with our colleagues for many months on improving the quality of service we are able to offer patients across Hertfordshire, and this is one great example of good collaborative working that has benefit to all agencies. If we are waiting to hand over our patients at the front doors of our local hospitals, then we are unable to respond to life-threatening 999 emergency calls in surrounding areas. I am very happy that the many months of work are now proving to have a real impact on patient safety and care”.
The improved performance at the Lister has other benefits too – patients who were the most sick (e.g. suspected sepsis, stroke, cardiac and other acutely unwell people) are now being identified much more quickly, which means they are being seen by relevant specialist teams and treatment starting faster than before. For patients, their waits on trolleys have also been reduced significantly – which means a better overall experience for them.
The work on improving ambulance handover times at the Lister’s emergency department, including recent changes made to the initial triage/patient streaming systems, as well as how the next steps in someone’s treatment are escalated more quickly once a decision is made to admit them or discharge them back home. Along with investment of an additional £600,000 funding announced by the Department of Health recently for further improvements to be made to the department’s layout, the overall aim is to ensure that the service’s improvement continues as it moves ever closer to meeting consistently the national A&E waiting time standard.