Paramedics have begun caring for patients in the emergency department as part of a Health Service initiative to stop ambulances queuing outside hospitals and ease the strain on overstretched emergency staff.
The scheme has resulted in much faster handovers of patients to a hospital which is one of the worst in England for sick people stuck, sometimes for many hours, in the back of an ambulance.
Queen’s Hospital in Romford, east London, has set up an ambulance reception center (ARC) near its main emergency department, where two London Ambulance paramedics are on call 24 hours a day to help care for patients who otherwise would be trapped outside or in a hallway waiting to be seen.
Patients who end up in the new six-bay unit behind the ED have a better experience while they wait and are more comfortable – and safer – because they can have their relatives with them, eat and drink and use the toilet more easily.
Almost 2,000 patients have passed through the ARC since it opened last November, saving ambulance crews nearly 13,000 hours of time and allowing them to respond more quickly to emergency calls.
Some emergency doctors consider the scheme simply a “sticking plaster”, given that ambulance queues have become common outside many hospitals and that emergency departments treat the lowest percentage of patients within four hours on record.
Matthew Trainor, chief executive of the Barking, Havering and Redbridge Trust, which runs Queen’s, admits “we still have too many delays in delivery”. But, he pointed out, ARC has also brought about a big improvement in the hospital’s previously difficult handover times.
The number of people arriving by ambulance at Queen’s A&E rose from 1,529 in February to 1,788 in May. Over the same period, however, the proportion of those who had to wait at least an hour to be handed over dropped from 27.4% to 19.4%, Trainor added.
Last Wednesday afternoon, all six cabins were full, mainly with older people who had fallen or suffered an exacerbation of an existing illness. However, there were no ambulances outside waiting to unload a patient.
Some doctors consider the scheme to be a simple sticking plaster. Photo: PA Images/Alamy
In cabin four of the ARC, 71-year-old Mahan Singh was happy. He was quickly examined and given antibiotics for his persistent cough and a battery of tests to help doctors assess him. “This setup is good. It’s better than waiting in AG, which was my main concern coming into today,” he said.
Daniel Elkeles, chief executive of London Ambulance Service (LAS), said: “ARC means patients benefit, the ambulance benefits and people waiting for a 999 call to be answered benefit too.”
NHS England bosses believe the partnership could be adopted elsewhere. Whipps Cross Hospital in east London has introduced a similar facility and managers from other NHS trusts have been in Romford to see how it works.
Not everyone is impressed, however. The Royal College of Emergency Medicine, which represents emergency doctors, called the ARC “short-sighted”. Catherine Henderson, president of the college, said: “Pre-ED handover models are not recommended by RCEM. Instead of focusing on managing demand at the front door, we need to look at solutions around flow and discharge [of hospital patients].”
She likened the scheme to NHS England’s plan, proposed in March but never implemented, to treat patients in tents in hospital car parks to ease the strain. “Not only did they not matter, they were impossible to manage with staff and posed serious safety risks.” The initiative was just corridor care by another name.”
Improving social care to free up beds by enabling faster discharges for older patients who are medically fit to leave but need support afterwards would do more than anything else to end the long lines, Henderson added. “Short-sighted ‘temporary’ solutions do nothing to address the crisis,” she said.
However, Martin Flaherty, managing director of the Association of Ambulance Chief Executives, hailed the ARC as “a positive example of what can be achieved when a whole system approach is taken to reduce hospital handover delays in emergency departments.
“Tackling unnecessary delays – and the resulting effects on ambulance turnaround times, staff welfare and patient harm – is the key action that can be taken to ease the pressure on the ambulance sector and enable us to get back on the road so we can respond to more patients who need our life-saving care,” he said.
But a senior ambulance sector official said that while ARC “is a step in the right direction, it still requires ambulance staff to be present to care for the patient, thus keeping them off the road elsewhere”. The ideal, he added, would be an ARC-type facility in every hospital, but staffed entirely by emergency personnel so that all paramedics could leave immediately after the handover was complete.
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