Delays in the handover of ambulance patients into hospital care has for several years been recognised as a significant issue.  This is particularly true for the high number of frail and elderly patients who use ambulance services.  In the North West in 2017/18, over 700,000 patients were taken to hospital by ambulance.  On average it took 35 minutes from arrival at hospital to the point ambulance crews were ready for the next call. However some average times were in excess of 40 minutes, and some individual times considerably longer.  This not only led to poor patient experience, but to delayed hospital assessment and definitive treatment.  The long waiting times also meant that there were fewer ambulances available to respond to 999 calls from patients in the community.

In September 2018 we set up Every Minute Matters – an improvement scheme that saw us working together with hospitals, commissioners and other stakeholders to reduce ambulance turnaround times, improving patient experience and safety. 14 hospital sites across the North West took part in the initiative.

The improvements they made to the ambulance handover process ranged from quick fixes such as moving the hospital wheelchair bay closer to the ambulance parking area, to more long term solutions such as the development of a rapid triage tool for ambulance patients, and other hospitals were keen to learn from their experience.  The work done by these sites made a significant impact:

• In 2020/21 the average turnaround time for EDs in the North West had dropped to 29 minutes – 6 minutes less than in 2017/18.
• 22 of the 30 ED sites in the North West were either at or below the national 30 minute target, compared to just 8 in 2017/18.

But there is still more work to be done. COVID-19 has brought more challenges, including the need for greater social distancing and rapid COVID testing to determine whether patients are suffering from the virus. On top of that, the NHS as a whole is facing increased demand and pressures, bringing with it even more extreme challenges.

In response to this, and the pressure on ambulance handover times that this creates, we’ve set up new initiatives to reduce handover time and promote patient safety:

• We’ve created a training package designed to equip ambulance managers to work with hospitals.
• Our Patient Safety Team continuously evaluates any instances of potential patient harm in order to communicate these to relevant hospital sites.
• We’ve developed action cards listing actions to be taken in the event of long handovers, with the aim of minimising patient harm.
• We’ve established direct access to specific wards for some ambulance patients.
• We’re working to implement a handover safety checklist and a ‘Fit 2 Sit’ checklist at several sites across the North West.
• We are in the process of creating a training package for all hospital and ambulance services in England to help with handover improvements

We will continue to work together with hospitals in the North West, in order to share the learning gained from the Every Minute Matters initiative, helping them to streamline their handover process and minimise patient delay.