Herts hospital chiefs aim to cut ambulance waits
It's claimed some patients have waited up to five hours to be handed over from the ambulance to the emergency department at Lister Hospital
Ambulances can have to wait more than five hours to handover patients to the emergency department at the Lister Hospital, it has emerged.
And on some days there can be as many as 10 ambulances waiting at the Stevenage hospital at once.
National NHS officials have now stepped in to instruct hospital chiefs across the country to review and address delays in handing over the care of patients, from ambulances to emergency departments.
And on Wednesday the ongoing review at the Lister was highlighted to a meeting of the East and North Hertfordshire NHS Trust.
According to national policy ‘ambulance handovers’ should take no more than 15 minutes – ensuring patients receive necessary care and ambulances get back on the road.
But data presented to the board shows that in September fewer than one in 10 ‘ambulance handovers’ at the Trust – just seven per cent – were completed within the 15 minutes target.
On 783 occasions it took in excess of 30 minutes – and on 336 occasions it took more than an hour.
Meanwhile average handover times reported to the board ranged between 24 and 78 minutes – with maximum handover times ranging between 54 and 321 minutes.
In a letter sent to the Trust, senior national and regional officials from the NHS have acknowledged that staff are already ‘working incredibly hard to resolve this problem’.
They stress that action must be taken to ensure ambulances are not used as additional emergency department cubicles – and that crews can safely offload patients to the care of emergency departments.
And to address delays they highlight initiatives such as ‘surge capacity’ and ‘fit to sit’ for patients that do not require a trolley – as well as measures to enable earlier discharge.
They also highlight the potential use of GP streaming, community and mental health service capacity to reduce the number of patients taken to hospital emergency departments.
At the meeting, the actions being taken by the Trust were outlined in a report by chief operating officer Julie Smith.
She acknowledges it is “a very challenging ask” – and pointing to partners in the hospital and the community, she stresses the need for ‘a collective response’.
“It is important that it is regarded not only as a ENHT issue to resolve but one that system partners need to work together to address,” says the report.
“Every part of the pathway from the community, to the hospital and back to the community can cause delays and bottlenecks and so a collective response is required.”
At the meeting, it was reported that one of the Trust’s preferred options is for ‘additional temporary capacity’ – such as a porta cabin – in the car park for the ED at the Lister.
And it was reported that they already plan to have an additional ‘decision-maker’ available in ED after 5pm during the winter months – that would ‘support flow out’ and increase capacity for those coming in.
According to the report, the Trust is also looking at whether – or not – it could create an admissions unit in the existing ‘discharge lounge’ at the Lister, where ED patients could wait until a bed was available.
And they are looking at initiatives that could increase capacity in the hospital for new patients by enabling earlier discharge.
That could be, for example, moving patients who are waiting for transport home to move to the ‘discharge lounge’ or exploring additional community capacity.
Meanwhile the report also highlights the possibility of discussions to increase additional support for mental health patients – diverting mental health patients away from the ED ‘to a more appropriate alternative setting’.
At the meeting Trust chief exec Nick Carver acknowledged the letter from officials – but stressed that this was an issue the Trust was already aware of and takes “extremely seriously”.
“For the absolute avoidance of doubt, whilst I am very happy to receive a letter – we do not need a letter to remind us of the importance,” he told the board.
“… We know that if we have any delays here, it delays the time that an ambulance takes to get to a patient at home.
“So we fully understand this – we haven’t suddenly started to become focussed upon this.
“We think we do better than many other place. We think frankly our facilities help us but we do – again for the avoidance of doubt – recognise there’s more we can do individually and as a system to reduce the delays still further.”
Meanwhile data presented to the East and North Hertfordshire NHS Trust board also highlighted the increasing number of patients seeking emergency treatment – and how long they were having to wait.
In September 16,086 were seen at Accident and Emergency at the Lister Hospital or the Urgent Care Centre, at the QEII Hospital.
That’s equivalent to 536 patients a day – and it’s 35 per cent more than were seen in October the previous year (2020).
Almost three in every 10 patients seeking emergency care from the Trust in September had to wait more than four hours.
National NHS targets say that 95 per cent of patients should be seen and treated at an emergency department within four hours.
But data presented to a meeting of the East and North Herts NHS Trust on Wednesday (November 3) shows that in September 69.5 per cent of patients waited in excess of four hours.
The average waiting time for patients who were not admitted was in slightly in excess of three hours and 10 minutes.
For those who were admitted was eight hours and 40 minutes.
And more than 1000 patients were recorded as having waited for more than 12 hours.
According to the reports to the board in September there were no 12-hour trolley waits recorded.