Director of Service Delivery, Kevin Brown, updates on hospital handover

Staff with patient on stretcher at accident and emergency

In my recent video message, I talked about the arrival to handover waits at hospitals, the huge impact these have on you and our patients, and the corresponding regulation and commissioning challenges we deal with. 

We continue to work closely with the whole health system and regulators to try to resolve and reduce these delays. Every A&E delivery board (boards that are focused on urgent and emergency care and made up of representatives from all the health service) is getting our visual presentation of the impact handover delays so as to continue, to drive home the message of this being unacceptable and putting our patients at risk.

In doing this, we need to make sure that our own house is in order too. We see significant variation across the region in the understanding of when handover occurs and the expectations around handover.

All the total time that we are at hospital, we have patients waiting in the community and this is a poor experience for them and for you when you arrive. As such, we all have a responsibility to play our part in doing our best for patients, and the outstanding acre we give them, by reducing the time at hospital wherever possible.

In talking with many of you over the last few weeks, and with the support of SSG Healthcare who are working with us on financial improvements, it has become increasingly clear that there is not a common understanding of the terminology used and the expectations of you as clinicians in the overall time at hospital and the impact on the Trust of this. I thought that it would be helpful to clarify some of this.

‘Arrival to handover’ is from the time you arrive at hospital to the patient being off your trolley/equipment and includes the clinical handover. The handover time should only ever be recorded once both of these are complete. Once handover has been achieved, we should leave and not remain with the patient as this is now solely the hospital’s responsibility.  There appear to be times where we stay and continue to do the hospital work in caring for the patient. Whilst I recognise we are all totally patient focussed, once we have handed over the patient the hospital is then responsible for that patient. Our attention has to become the patient that is waiting for us in the community.

‘Handover to clear’ is from the moment your patient is clinically handed over and off your trolley to you being available to respond to the next call in the community.

The expectation nationally is that each element takes a maximum of 15 minutes. We see too many instances where the arrival to handover exceeds 15 minutes and we are working with hospitals and regulators to raise and address this as it is largely out of our control. However, the flip side for us is that the handover to clear element also has a 15 minute target and that is the expectation on every one of us. The national expectation is that this is achieved 95% of the time on average.

I do of course know that a small number of calls require longer for various reasons despite your best efforts. Where you are not able to achieve this ‘clear’ time, it is important that EOC know as they may be holding 999 calls and can potentially offer you better support if required. We will be looking to share some guidance on what to do if you experience delays so that we can support you.

In terms of ongoing support, you will know we are working hard to try and get more of you off duty on time than in the past and this is the ‘intelligent X-ray’ pilot now operating across the whole region. We also are improving on getting you onto a meal break. We are continually looking at the most effective way to achieve these and how to embed them into normal operations to ensure that support is available when you need it. We have also invested more into TRiM, and I have recently trained as a TRiM practitioner to offer my support to colleagues in a time of need.

If during the shift it is unsafe for you or your vehicle to continue being available at any point, we want to be able to give you the right support. At times this will mean we proactively make you unavailable for any call or put you into an IX code-set. Sometimes the right solution is neither, but to find a solution that does not take capacity away from our patients.  In part of Essex, we are piloting a different approach to supporting you when you or your vehicle need support, and we will see if we can learn from all the good things in place to provide a positive overall improvement.  This will also help support our EOC colleagues who have to manage the incoming and outstanding 999 calls and to address the fact that we are losing too much response capacity unnecessarily at times. And this adds to the pressure on you and impacts on you getting rest breaks and off on time.

We will keep you updated – thank you for your ongoing patience and support.


Published 2nd March, 2017

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