Ambulance Conveyances to Hospital
Patients have been experiencing long delays at hospitals when ambulances transport them to A&E or admissions units. Ambulance crews attending hospitals have to hand-over the patients to hospital staff. Recently there have been instances of these hand-overs taking up to two hours due to shortage of staff to hand over to. This is bad for the patient, as they remain on an ambulance trolley for this time, and do not receive the care that they require until the hand-over has happened.
There are many reasons for these delays which the hospitals and ambulance service have been working to rectify. One of the factors which has been identified is that many ambulances arrive at A&E and admissions units in clusters which coincide with GP visiting times. Practices rightfully prioritise home visits on clinical need, but often these are carried out after morning and afternoon surgeries. This causes there to be “bulges” in the requests for ambulance conveyance in the early and late afternoons. These “bulges” lead to multiple ambulances arriving at the hospitals in batches. The first ambulance to arrive hands the patient over, but the second, third, fourth etc. have to wait.
The bulges also reduce the capacity of the ambulance service to attend patients, as ambulances are already conveying other patients, this leads to delay in collecting the patients.
The LMC know that practices have to plan their days according to patient demand, and that we should not have to restructure our days to improve processes at the hospitals and ambulance trusts. However, we have been asked to identify ways in which the load of ambulance conveyances could be spread more evenly. For instance, some practices are using home visiting practitioners who visit throughout the day to spread the workload. Others perform visits throughout the day and not just after surgeries.
Another solution would be to communicate to the ambulance service that the conveyance is non-urgent, and can be completed when the “bulge” has receded. EMAS has requested that clinicians, not administrators, request ambulance conveyance, as EMAS have many examples of administrators being unable to answer clinical questions, and thus the call handler has to place the request in an inappropriately high category.
The LMC welcomes feedback from practices about how they manage this difficult situation.