Ambulance handovers

Our inspectors have reported ongoing challenges around ambulance handover delays at emergency departments, which has raised concerns about patient safety.

Once it arrives at a hospital, an ambulance is not a suitable place for a patient to receive treatment or wait to be admitted. Furthermore, a parked ambulance is not available to attend other emergencies and ambulance crews are sometimes unable to end their shift because they can’t leave the patient.

In a survey of UK emergency department clinical leads, conducted in August 2021 by the Royal College of Emergency Medicine, half of respondents said their emergency department had been forced to hold patients outside in ambulances every day. This compared with just over a quarter in October 2020 and less than a fifth in March 2020.

In our March 2021 COVID-19 insight report, we looked at the first five of 13 inspections of hospital emergency departments that took place between 30 November and 21 December 2020, and how they had responded to the challenges of COVID-19 during the winter period.

Most of the departments were not queuing or cohorting patients in corridors to avoid overcrowding and maintain social distancing during the pandemic. However, this had a knock-on effect on ambulances. Patients were being held in ambulances, either awaiting treatment or until a place on a ward could be found.

The implementation of rapid assessment and treatment (RAT) systems was helping to address problems in some departments. However, progress was slow in one case, with just under half of patients not meeting the hospital’s 15-minute handover target in December 2020. At another hospital there were long ambulance handover delays where medical and nursing staff were not able to ensure patients waiting in the ambulances always received timely clinical intervention. The delays also had an impact on ambulance crews’ wellbeing and their ability to respond to other patients in the community.

At all the hospitals inspected, inspectors found that the wider capacity of the hospital was a factor on delays in the emergency department. Hospitals wards were operating routinely at capacity, often having been reconfigured themselves to allow for the social distancing and streaming requirements of the pandemic, and this was affecting patient flow. We heard about delays in ambulance turnaround times, with patients being held in ambulances due to capacity issues in the emergency department and the wider hospital.

Some hospitals had oversight of the risks and these were well managed. However, at other hospitals there was no clear governance structure in place and risks were not effectively managed.

Some of the hospitals were demonstrating good partnership working with ambulance trusts. Emergency department staff worked with hospital ambulance liaison officers (HALOs) to support patient flow. Ambulance crews could pre-alert departments to the arrival of certain conditions and be greeted by HALOs to divert patients for speedy treatment. They attended hospital meetings to support good communication and could oversee patients in corridors during busy times so ambulances could be released.

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