Ambulance handover delays arise when emergency departments become overcrowded as patients waiting prolonged periods for admission occupy clinical cubicles designed to facilitate the assessment and treatment of emergency arrivals. In response, many organisations become reliant on temporarily lodging acutely unwell patients awaiting admission in undesignated areas for care such as corridors, to provide additional space. This results in a significant risk of avoidable harm, indignity and psychological trauma for patients and has a negative effect on the well-being of healthcare professionals, since unacceptable standards of care become normalised. A two-phase strategic quality improvement project was implemented at the authors' acute trust. Ambulance handover data from between 2 November 2020 and 26 July 2021 provided a benchmark for the project. The first phase was implemented between 2 November 2021 and 26 July 2022 and aimed to reduce 60-minute ambulance handover delays. The second phase was implemented between 2 November 2022 and 26 July 2023 and aimed to eradicate 60-minute ambulance handover delays and improve overall performance. Phase one resulted in a 32% reduction in 60-minute ambulance handover delays. Phase two resulted in a 97% reduction in 60-minute ambulance handover delays. Over the course of the project there was a 24% increase in handovers completed within 15 minutes. This project demonstrates how strategic planning and collaboration between healthcare teams can reduce the potential for avoidable patient harm, while simultaneously promoting workforce well-being and retention.
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http://dx.doi.org/10.7748/en.2024.e2199 | DOI Listing |
BMJ Open
March 2025
South East Coast Ambulance Service NHS Foundation Trust, Banstead, UK.
Objectives: Ambulance clinicians use prealert calls to advise emergency departments (ED) of the arrival of patients requiring immediate review or intervention. Consistency of prealert practice is important in ensuring appropriate ED response to prealert calls. We used routine data to describe prealert practice and explore factors affecting variation in practice.
View Article and Find Full Text PDFIntroduction: Falls in older adults are common, leading to high rates of emergency admissions, extended hospital stays, and unnecessary use of healthcare resources. This service evaluation reports on a home-deployed imaging service using mobile X-ray equipment to explore the potential cost-effectiveness and patient benefits of facilitating imaging at the patient's place of residence.
Methods: A six-month pilot program was established involving transporting portable imaging equipment to patients' homes or care facilities in Cornwall as required.
BMC Med Res Methodol
January 2025
Prehospital Center Region Zealand, Ringstedgade 61, 14th Floor, Naestved, 4700, Denmark.
Background: Effective interventions to reduce drowning incidents require accurate and reliable data for scientific analysis. However, the lack of high-quality evidence and the variability in drowning terminology, definitions, and outcomes present significant challenges in assessing studies to inform drowning guidelines. Many drowning reports use inappropriate classifications for drowning incidents, which significantly contributes to the underreporting of drowning.
View Article and Find Full Text PDFScand J Trauma Resusc Emerg Med
December 2024
Ornge, Mississauga, ON, Canada.
Introduction: Pre-alerts from paramedics to trauma centers are important for ensuring the highest quality of trauma care. Despite this, there is a paucity of data to support best practices in trauma pre-alert notifications. Within the trauma system of Ontario, Canada, the provincial critical care transport organization, Ornge, provides pre-alerts to major trauma centers, but standardization is currently lacking.
View Article and Find Full Text PDFEmerg Med Australas
February 2025
Joseph Epstein Centre for Emergency Medicine Research at Western Health, Sunshine Hospital, Melbourne, Victoria, Australia.
Ambulance ramping, the delay to transfer of a patient arriving at an ED by ambulance into an ED treatment space and handover of care to ED clinicians, is a problem in all Australian states and territories and New Zealand. It is a symptom of ED overcrowding and access block and has been associated with adverse health outcomes for some patient groups. The questions arise, who might be legally responsible for the care of patients who are ramped and does their physical location matter? The short answers are 'everyone' and 'no', however, whether there will be a breach of duty depends on the reasonableness of responses and resource allocation considerations.
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