A&E: The best start of a patient’s journey is the one without delays

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Posted 16th November 2017 by Sanne van der Palen

A paramedic handover: The best start of a patient’s journey is the one without delays.

According to the official guidelines of NHS England, ambulance patients should be handed over from the ambulance to Accident & Emergency care within 15 minutes. However, the number of ambulance patients waiting more than an hour to be transferred to A&E services has more than doubled over the last two years. There were 111,524 people who waited at least 60 minutes in an ambulance in 2016-17, up from 51,115 in 2014-15.

Obviously, this number is rising steadily, which isn’t a positive development. The question which arises from this is: ‘Is it realistic to hand a patient over from ambulance to hospital in only 15 minutes?’

That’s an interesting question to answer. First, we need to understand what a paramedic handover consists of. Providing timely, coordinated and seamless care to patients as they are handed over from the ambulance service to Accident & Emergency is a key component in the delivery of high-quality care. This means following the Professional Records Standards Body (PRSB) standards on handover documentation.

Can that be realised in the 15 minutes available without too much pressure on ambulance employees? With delays caused by documentation, backlogs in A&E and increasing use of Urgent Care Centres to cope with overflow, how can it this achieved?

I think this is achievable – as long as the handover starts the minute an emergency call is made.

At every stage of an emergency call, information is collected about the patient and the incident. Why isn’t that vital information shared with the paramedic so that they can start populating their pre-hospital documentation? Producing duplicate information is a time-consuming activity in precarious situations such as these.

If the paramedic is collecting information and making decisions, why can this not be captured at point of care and structured so that it can be made available to the relevant people in A&E? That way, inbound ambulance patients can be triaged and prioritised exactly as walk-in patients are, and if they are deemed fit enough to wait then they can be discharged from the ambulance’s care into the A&E’s care.

If this was all done electronically using mobile technology, speech recognition and workflow management, it would not only save time but also allow the analysis, in real time, of patient flow management and the moving around of resources to make patient care more effective.

This is why most Trusts are starting to look at Transfer of Care from one organisation to another; but why are they not bringing these same concepts into their own organisations? Technology which is already available can be leveraged to reduce these handover times and ultimately save lives, so why are we not using it? That’s probably the biggest question.

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