Study seeks to address time it takes for patients to be admitted to emergency departments

In England more than half of handovers exceed the 15-minute target. In December, under sustained pressure, the Welsh Ambulance Service declared a critical incident after more than half its vehicles were stuck outside emergency departments, waiting to hand over patients so they could attend other 999 calls.

A review by the Association of Ambulance Chief Executives found that more than 85 per cent of patients queuing for 60 minutes or more at English hospitals potentially suffered harm.

Now a new study by PRIME Centre Wales – a research centre focusing on primary and emergency health care co-led by Cardiff University, Bangor University, University of South Wales, and Swansea University  - is seeking to improve understanding of the impact these handover delays have on patients and find out how to improve the situation.

Called STALLED - What works to improve SafeTy, pAtient experience, outcomes and costs reLated to deLayed ambulance handovers at Emergency Departments – the £1.5 million project is being led jointly by Professor Helen Snooks, from Swansea University and Professor Andrew Carson-Stevens, of Cardiff University, collaborating with partners from ambulance services across the UK.

Professor Carson-Stevens said: “Our aim is to provide evidence-based guidance about what works to reduce hospital handover delays and related harms.”

The researchers have conducted a survey of ambulance services and hospitals to find out what initiatives are being done at various places to reduce handover delays. The responses included:

• Use of additional staff and other staff-related changes;
• Use of additional space;
• Changes in handover/discharge process(es);
• ED clinician care provided on ambulances; and,
• Ambulance service staff providing care within ED.

The team has also analysed publicly available performance data to investigate how handover delays vary.

Study Manager Dr Mark Kingston from Swansea University, said: “Using data from 105 hospital trusts, from October 2023 to March 2024 we found a huge variation in average handover times per month – from 8mins, 45secs up to 129mins, 6secs.”

The next stage of the study will see the team working with four ambulance services and eight hospitals across the UK - half where handover delays are relatively low, and the others where they are relatively high. Its plans include:

• Comparing deaths, 999 ambulance attendance, ED conveyance, hospital admissions, wait times;
• Undertaking a clinician review of 2,328 anonymised patient ambulance service/hospital notes to compare incidents of harm;
• Sending out questionnaires to 2,800 patients to discover more about their experiences, and safety concerns;
• Interviewing patients and staff to find out about their experiences and views;
• Using patient flow data to determine initiatives that may be more beneficial ;
• Assessing the costs related to handover delays; and,
• Holding stakeholder workshops.

This information will then be used to produce written guidance and recommendations about how to reduce ambulance queuing to improve patient care and outcomes.

Ambulance service leaders have warmly welcomed the three-year study.

Managing Director of The Association of Ambulance Chief Executives (AACE) Anna Parry said: “It is vital to consider the harm being caused to patients and the intolerable impact this is having on our staff who are caring for them.

“The impact is felt in our communities too, where patients are having to wait far too long for an ambulance to arrive, and our call-handlers and clinicians in our call centres are having to watch significant numbers of calls stacking with no available resource to dispatch.”

She warned: “It is significantly affecting the health and wellbeing of staff and their ongoing education at a time when we really need all of the urgent and emergency care workforce to be developing and thriving.”

Adele Battaglia, patient and public contributor on the study, said: “Delays in handover can result in catastrophic experiences for patients and their loved ones, causing significant disruption to the flow of patient care that can leave staff feeling frustrated. This research is vital in learning more about the consequences and what can be learnt to help future service users and staff."

Interim Head of Research Operations, South Central Ambulance Service, Helen Pocock added: “We feel that it is of the utmost importance to work with stakeholders to investigate, and find ways to reduce, these delays.  This will benefit everyone, including the wider NHS community.”