In England, a pressing issue in emergency healthcare relates to the time it takes for patients to be admitted to emergency departments. In December, the Welsh Ambulance Service declared a critical incident when more than half of its vehicles became stuck outside emergency departments, unable to hand over patients to attend other emergency calls.
A recent review by the Association of Ambulance Chief Executives indicated that over 85 percent of patients waiting for 60 minutes or more at English hospitals potentially suffered harm from these delays.
Addressing this issue, PRIME Centre Wales—a research center focused on primary and emergency healthcare and co-led by Cardiff University, Bangor University, University of South Wales, and Swansea University—has launched a new study to investigate the impact of handover delays and explore ways to improve patient experience and outcomes. The study, named STALLED, is a £1.5 million project led by Professor Helen Snooks from Swansea University and Professor Andrew Carson-Stevens of Cardiff University, in collaboration with partners from ambulance services across the UK.
Professor Carson-Stevens stated, "Our aim is to provide evidence-based guidance about what works to reduce hospital handover delays and related harms." The team conducted a survey involving ambulance services and hospitals to identify various initiatives aimed at reducing handover delays. These included the employment of additional staff, utilization of extra space, changes in handover processes, as well as innovative approaches like providing emergency department clinician care on ambulances and having ambulance service staff deliver care within emergency departments.
Study Manager Dr. Mark Kingston from Swansea University shared that analysis of performance data from 105 hospital trusts between October 2023 and March 2024 revealed a wide variation in average handover times per month, ranging from 8 minutes and 45 seconds up to two hours and 9 minutes.
The subsequent phase of the study will involve collaboration with four ambulance services and eight hospitals in the UK, where researchers will assess facilities with both low and high handover delay rates. The study will compare deaths, ambulance attendance, emergency department conveyance, hospital admissions, wait times, undertake clinician reviews of anonymised patient notes, distribute questionnaires to gather patient experiences, conduct interviews with patients and staff, evaluate patient flow data, and assess costs related to handover delays. The results will be used to create guidelines and recommendations aimed at reducing ambulance queue times.
The study has received a positive response from leaders in the ambulance service sector. Anna Parry, Managing Director of The Association of Ambulance Chief Executives, emphasized the critical nature of understanding the harm caused to patients and the strain on healthcare staff. Parry noted, "The impact is felt in our communities too, where patients are having to wait far too long for an ambulance to arrive, and our call-handlers and clinicians in our call centers are having to watch significant numbers of calls stacking with no available resource to dispatch."
Adele Battaglia, a patient and public contributor to the study, remarked, "Delays in handover can result in catastrophic experiences for patients and their loved ones, causing significant disruption to the flow of patient care that can leave staff feeling frustrated."
Interim Head of Research Operations at South Central Ambulance Service, Helen Pocock, highlighted the importance of stakeholder collaboration in finding ways to reduce delays, asserting, "This will benefit everyone, including the wider NHS community."