Patient story triggers change to tackle handover delays

Maxine Power, NWAS

The story of an elderly patient suffering chest pains who had to wait almost two hours for a 999 response because ambulances were queuing outside hospital has prompted one service manager to set about changing the system.

Maxine Power had joined North West Ambulance Service as director of quality, innovation and improvement around the same time that the new ambulance response standards had been introduced in 2017. She said:

Looking at the A&E department, I saw chaos and patient care that was substandard and it bothered me. I met the patient’s wife and I found that her story was not an isolated incident. Both their lives changed beyond all recognition as a result of our inability to get to her husband in time. This is equivalent to some of the biggest catastrophes in the NHS.

What Maxine did next has captured the interest and attention of the NHS across the country and she outlined her innovation at the latest Council meeting of the Association of Ambulance Chief Executives – a body consisting of the chairs and chief executives of every NHS ambulance trust in the UK. Maxine told the AACE Council at its July meeting;

It took us six months to figure out what to do. Everyone says that they are working to reduce hospital handover delays, but this effort has almost created an inertia in the system so that there is no improvement.

She did this by focusing on the numbers of ambulance hours lost to handover delays and then concentrating on those hospitals with the largest number of hours lost. From this, there were six ED departments that stood out as needing immediate attention. “We had done a lot of work on handovers, but not in this way before,” she added.

Following the methodology from the Institute for Healthcare Improvement, she set her goal to halve the total ambulance-hospital turnaround time from 41 minutes to just 20 minutes at these six hospitals.

Three hospital sites have achieved the goal; another two have reduced total turnaround time but did not reach the 20 minute goal; and only one did not succeed.

Maxine continued:

The approach did not suit everyone and where the method was not applied in all cases we saw that we did not achieve our goal. However the evidence shows us that this was a statistically significant improvement.

This methodology was used in the 1980s to tackle access to primary care and it’s been used to tackle patient safety issues and pathways of care; but not in the ambulance service in a systematic way.”

Having learned from both the successes and failures across the initial six sites in the North West, her next steps are to adapt this approach to another ten hospitals in the region and eventually across the whole NWAS area.