THE JAM IN THE SANDWICH, DOWN HERE IN A&E': STAFF PERSPECTIVES ON THE IMPACT AND CAUSES OF HANDOVER DELAYS BETWEEN THE AMBULANCE SERVICE AND THE EMERGENCY DEPARTMENT

Background Delays to the handover of patients from ambulances to the emergency department (ED) cause operational challenges for hospitals and the ambulance service, and have attracted considerable public and policy concern. As part of a wider study of handover delays, we sought to understand the perspective of health service staff on their impact and causes, in the ED of a large teaching hospital. Methods We conducted semi-structured interviews with a stratified sample of key staff from the hospital and the ambulance service, including doctors (n=5); nurses (n=7); hospital based support staff (n=2); paramedics and ambulance technicians (n=12); and other ambulance service staff (n=8). All interviews were recorded and transcribed in full, then analysed using the framework approach. Results All staff groups expressed concerns about the impact of crowding and handover delays on the quality of patient care, with a minority of respondents identifying clinical risk to patients. Handover delays were associated with high levels of stress for all staff groups, and in particular frustration for ambulance clinicians tied up waiting with patients outside the hospital. Delays were felt to have an impact on the relationship between professional groups. The negative impact on ambulance service performance measures was felt to be substantial. There was a high level of consensus that problems of crowding in the ED were complex, with issues right through the system. Almost all respondents identified lack of capacity elsewhere in the hospital as an immediate cause, and reflected positively on the impact of recent initiatives to improve patient flow. Batched arrival of ambulances, associated in part with shift patterns, was reported as causing knock-on delays from which it was hard to recover. Conclusions Handover delays at the ED have a negative impact on patients, staff and health service organisations. System-wide impacts suggest that system-wide approaches to resolving delays are required.