The Association of Ambulance Chief Executives (AACE) has published a report following a structured clinical review of handover delays at hospital emergency departments across England. This revealed for the first time the extent of potential harm that is being caused to patients when they must wait in the back of ambulances or in corridors before they are accepted into the care of their local hospital.
The review found that the proportion of patients who could be experiencing unacceptable levels of preventable harm is significant. Over eight in ten of those whose ‘handover’ (from ambulance clinician to hospital clinician) was delayed beyond 60 minutes were assessed as having potentially experienced some level of harm; 53% low harm, 23% moderate harm and 9% (one patient in ten) could have been said to have experienced severe harm.
The impact assessment was coordinated by AACE and was undertaken in all ten English NHS ambulance services who reviewed a sample of cases from one single day in January 2021, where handovers exceeded one hour.
Experienced clinicians assessed the range and severity of potential harm experienced by those patients who were already seriously ill, frail or elderly and who waited for sixty minutes or more before being accepted into the care of the hospital from the ambulance crews in attendance.
The nationally defined target for hospitals included in the NHS Standard Contract states that all handovers between ambulance and A&E must take place within 15 minutes, with none waiting more than 30 minutes. Since April 2018, an average of 190,000 handovers have missed this target every month (accounting for around half of all handovers) while in September 2021 over 208,000 exceeded the 15-minute target.