Increased Ambulance Handover Delays Threatening Patient Safety, RCEM and College of Paramedics Warn


Increased ambulance handover delays threatening patient safety, RCEM and College of Paramedics warn

A new snapshot survey by the Royal College of Emergency Medicine has found that in August 2021 half of respondents stated that their Emergency Department had been forced to hold patients outside in ambulances every day, compared to just over a quarter in October 2020 and less than one-fifth in March 2020.

The survey, sent out to Emergency Department Clinical Leads across the UK, also found that half of respondents described how their Emergency Department had been forced to provide care for patients in corridors every day, while nearly three-quarters said their department was unable to maintain social distancing every day.

One-third said that the longest patient stay they had had in their Emergency Department was between 24 and 48 hours, with seven per cent reporting the longest stay to be more than 48 hours. 

Dr Ian Higginson, Vice President of the Royal College of Emergency Medicine, said:

“It is shocking to see the extent of the challenges faced by Emergency Departments across the UK. Holding ambulances, corridor care, long stays – these are all unconscionable practices that cause
harm to patients. But the scale of the pressures right now leaves doctors and nurses no options. We are doing all we can to maintain flow, maximise infection prevention control measures, and maintain social distancing. Our priority is to keep patients  safe, and ensure we deliver effective care quickly and efficiently, but it is extremely difficult right now.

“The data is stark, and this is August. Our members are really worried about what may come in autumn and winter. We have a duty to our patients and staff. Currently there is extremely high demand - for a number of reasons  - but demand is not the whole picture. Demand presents a challenge because of the limitations of hospital space, workforce shortages, difficulties arranging quick ambulance handovers, smooth care and safe discharge of patients from wards, and a lack of services and alternatives to admission, particularly in the evenings and at weekends.
“The health service entered the pandemic short of staff, with less beds, and underprepared. Throughout the pandemic these shortages have been felt, but with demand higher than ever before, and with a workforce that is burned out, these shortages are felt more acutely than ever.”

Commenting on the increase in ambulance handover delays, Tracy Nicholls, Chief Executive of the College of Paramedics, said:

“The College of Paramedics’ members also speak passionately about the potential for harm to those patients who, as a consequence of these lengthy ambulance handover delays, can wait an unacceptably long time for help. It is deeply concerning.
“Like the Royal College of Emergency Medicine, we recognise that all partners are working exceptionally hard to manage this situation and current demand. The reality is, however, that unless effective actions are taken now to ease the system pressures, more and more patients will face these delays as we head into another difficult winter, and both paramedics and ambulance clinicians across the UK will face the brunt of any further increase in demand.
“We urge NHS leadership to take action now to mitigate this risk wherever possible and protect both patients and our collective workforce from the inevitable pressure that we face if nothing is done.”

The survey also found that over 80% of respondents had little or no confidence in their organisation’s ability to safely and effectively manage the current or predicted combination of pressures as we head into winter.

Dr Higginson continued:

“The final response that found an overwhelming lack of confidence signals something deeply troubling. The College has consistently warned of the upcoming winter and ongoing pressures. It is time we saw leadership and an equivalent response. There must be a comprehensive plan for the current demand and upcoming winter that include short- and long-term solutions to tackle these serious challenges. If ambulance services and Emergency Departments cannot cope with ongoing pressures, then it is patients and the workforce looking after them who will suffer. The winter could lead the health service into a serious crisis. Patients and staff must have assurance that they, their Emergency Department and their hospital will get what they need to manage.”

About the Royal College of Emergency Medicine 

The Royal College of Emergency Medicine is the single authoritative body for Emergency Medicine in the UK. Emergency Medicine is the medical specialty which provides doctors and consultants to A&E departments in the NHS in the UK and other healthcare systems across the world. 

The Royal College works to ensure high quality care by setting and monitoring standards of care and providing expert guidance and advice on policy to relevant bodies on matters relating to Emergency Medicine.

The Royal College has over 10,000 fellows and members, who are doctors and consultants in Emergency Departments working in the health services in England, Wales, Scotland, and Northern Ireland, and across the world.

About the College of Paramedics

The College of Paramedics is the recognised professional body for all paramedics in the UK, whose role is to promote and develop the paramedic profession across England, Northern Ireland, Scotland and Wales.
The College was established in 2001, is a membership organisation with over 21,000 members, and a Charity, registered with the Charities Commission, since 2015. 

The College represents its members in all matters affecting their clinical practice, supporting them to achieve the highest possible standards of patient care through a broad membership of a variety of national stakeholder working groups, advisory committees and ongoing research projects. 

The College of Paramedics provides advice to members and student members alike and is a source of information and guidance for those who are considering becoming a paramedic. The College of Paramedics supports the paramedic profession through publication of a wide range of documents that underpin the profession.