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UPDATED

11 DEC 2023

Ditch normal procedures to avoid A&E handover delays, trusts told

By Lawrence Dunhill 11 December 2023​

• Winter letter tells trusts to focus on ambulance handover delays
• Comes amid debate over North Bristol model, where patients are admitted irrespective of bed capacity

Regulators have warned hospital leaders they may have to ‘depart from established procedures’ over winter to minimise ambulance handover delays.

In a joint letter to nursing and medical leaders, NHS England, the Care Quality Commission and professional regulators said it was “vital that we have a whole system approach to risk across the urgent and emergency care pathway”.

The letter added: “This includes considering actions within hospitals to help improve flow and reduce pressures on emergency departments. All national regulators will consider the need to keep regulatory oversight proportionate at this busy time, whilst maintaining the focus on patient safety and protection of the public.”

Over the last two years, national leaders have pushed for hospitals to allow ambulance crews to hand over patients more quickly. This typically means admitting patients from ED to the wards more quickly, irrespective of bed capacity.

North Bristol Trust said it has improved care by introducing this model, though there are concerns in some quarters about the safety risks it creates on inpatient wards.

The push has come amid a huge increase in instances of crews being held outside emergency departments, resulting in extended response times for time-critical 999 calls.

The letter, also signed by the Nursing and Midwifery Council and General Medical Council, added: “We… understand there will be concerns about working under pressure, and that you and your teams may need to depart from established procedures on occasion to provide the best care.

“Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision making in all circumstances. This includes taking into account local realities and the need to adapt practice at times of significantly increased pressure.

“In the unlikely event of a complaint to your professional regulator they will, as is their usual practice, consider carefully whether they need to investigate. If an investigation is needed, they will consider all relevant factors including the context and circumstances in which you were working.

“One area that may be an example of this is in handing patients over to emergency departments from ambulance services. There is a strong correlation between ambulance handover delays at emergency departments and ambulance category 2 response delays, meaning longer handovers increase the chances those in need will wait longer for an ambulance.”

The letter is similar to that sent last December, but gave the example of ambulance handover delays as a key area where staff may need to adapt to the circumstances.

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