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  1. Bridget Wells1,
  2. Bridie Angela Evans1,
  3. Alison Porter1,
  4. Becky Gammon2,
  5. Robert Harris Mayes3,
  6. Mark Poulden2,
  7. Nigel Rees4,
  8. Helen Snooks1,
  9. Alun Toghill3,
  10. Richard Whitfield4
  1. 1College of Medicine, Swansea University, Swansea, UK
  2. 2Abertawe Bro Morgannwg University Health Board, Swansea, UK
  3. 3PPI/Service user representative
  4. 4Welsh Ambulance Services NHS Trust, UK


Background Increasing pressure on the emergency care system contributes to delays in patient handover from ambulances to emergency departments. The impact of these delays includes ambulance queues, sub-optimal care for patients, staffing and operational challenges, and (in England) financial penalties.

New models of care have the potential to reduce handover delay. We surveyed ambulance services across England and Wales to produce a snapshot of initiatives under development or being trialled in order to address problems associated with handover delay.

Methods During 2014, we carried out semi-structured telephone interviews with R&D leads in all 11 independent ambulance service trusts in England and Wales. We asked respondents about initiatives taking place within their area, what evaluation was taking place, and what they believed to be the challenges to evaluation. Interviews were recorded and transcribed, and analysed using the Framework approach.

Results Initiatives fell into three groups: prehospital; at the ED; and whole system. Prehospital initiatives comprised clinical decision support tools (n=6); alternative pathways (n=6); hospital capacity monitoring (n=3); automated data transfer (n=3). Initiatives at ED included handover screens (n=8); rapid access models (n=7); hospital ambulance liaison officers (n=6); corridor care (n=3). Whole system approaches included new models of collaborative working (n=2); service review (n=2). Challenges to implementing and evaluating change included the lack of standardised approaches to handover across multiple hospital trusts within an ambulance service area; many of the reported initiatives took place only in a small part of the ambulance service's operational area. Only five respondents reported evaluation of handover initiatives, and of these two were described as informal evaluation only. The need to report and comply with performance targets was reported as a more immediate pressure than evaluation of new developments.

Conclusions While there is a range of activity taking place across England and Wales to address handover delays, there is little formal evaluation and there are missed opportunities for transferable learning.

  • emergency department

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