NHS Confederation encourages zero tolerance towards turnaround times.

Tuesday, 18 December, 2012

Collaboration to remove handover delays

A collaborative whole-system approach could make delays in ambulance turnaround times a 'thing of the past', says a new NHS Confederation report.

Impact on patients and NHS

With around 80 percent of ambulance handovers of patients to emergency departments taking place within 15 minutes, the NHS Confederation's latest report calls for ambulance services, acute trusts, primary care providers and commissioners to work together in taking a 'zero tolerance' approach to the remaining 20 percent.

Delays in handing over patients cause extended waits for treatment, are expensive and inefficient for the NHS, and can mean patients lack confidence in getting the right care in the right place when they need it.

Whole system issue

The report, Zero tolerance: Making ambulance handover delays a thing of the past, grew out of joint work between ambulance trusts, the acute sector, NHS commissioners and patient representatives, which scrutinized turnaround practice across the country. The most valuable learning to emerge has been distilled into ten recommendations, the first being that patient
handover delays are seen as a whole system issue.

Turning learning into practice

Other recommendations include the need to develop shared definitions for describing, monitoring and recording processes, and for representatives of each part of the system to work together at local level to address patient handover issues in their area.

Recommendations include:

• Patient handover delays should be seen as a jointly owned whole-system issue. Leaders from all parts of each local health economy should commit to work as partners to reduce delays in order to improve patient experience, care and safety.

• Hospitals, ambulance services and clinical commissioning groups (CCGs) should each identify specific individuals who commit to work together - and with social services colleagues and other partners - to explore, understand and address the causes of handover delay in their area and the impact they have on patient experience, safety and costs.

• Lead commissioners should actively seek support for a zero tolerance approach to handover delays in their health economy.

• Ambulance services, hospitals and commissioners should adhere to agreed, explicit and well understood definitions for describing, recording and monitoring handover processes, including key performance indicators (KPI) start and stop times.

• Ambulance services and acute trusts, with the support of commissioners, should develop common KPIs to support adherence to the national standard of 15 minutes for both
arrival to handover and handover to crew clear targets. Download the report and see all the

Zero tolerance approach

NHS Confederation interim director of policy, Jo Webber, said: "The vast majority of patient handovers between ambulance crews and hospital staff take place within minutes, but with nearly 5 million emergency ambulance journeys each year, and nine out of ten of these resulting in patients transported to an emergency department, it is right that the whole service looks at ways it can improve in this area.

"There are some innovative and highly effective examples around the country, and there have been some great successes at a local level. Now is the time for the NHS as a whole to take a zero tolerance approach on this.

"Any delay in handing over a patient at an emergency department is not good for the patient, means a delay in getting that ambulance back out on the road to attend to another patient and that means an unnecessary cost for the NHS as a whole.

Benefits for all

"But this is not a problem just for ambulance services and acute hospitals. Getting the right solutions in place is a job, which needs input from all health and care service components, including commissioners and the primary care sector to work out what the issues are at local
level and how they can be tackled effectively. "Increased efficiency on turnarounds will benefit the whole service, but even more important is the benefit patients will experience. It's a win-win situation."

Working together

Health minister Lord Howe said: "Everyone should be seen quickly when they arrive at hospital, even more so when they arrive in an ambulance. It is unacceptable for patients to be
left waiting in ambulances outside hospitals. "We want hospitals, ambulance trusts and commissioners to look closely at this report and work together to reduce long delays getting
patients into A&E.

"The NHS needs to ensure it has proper plans in place to deal with high demand and we are doing everything we can to support the service in treating patients as swiftly as it can."

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