Emergency medicine journal : EMJ
-
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. ⋯ 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.
-
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. ⋯ 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.
-
Members of the public are increasingly turning to ambulance services for help with urgent problems that could successfully be managed in primary care. The reasons for this are complex, and it is unclear whether variation exists across different global settings and between ambulance systems. ⋯ There is evidence to suggest socioeconomic and demographic characteristics traditionally associated with minority status and deprivation are associated with ambulance use for primary care problems. The role of formal and informal care-givers in influencing risk management warrants deeper exploration. There is a lack of consensus in the literature on what defines 'inappropriate' ambulance use, and from who's perspective this should be determined. Further work needs to explore these conflicts.
-
Identification of TBI is extremely difficult and is often missed in the pre-hospital setting. Major trauma triage tool (MTTT) criteria specifies the suspicion of an open or depressed skull fracture as indicating a major trauma patient. However, it is often the case that patients with TBI recorded on the Trauma Audit and Research Network (TARN) data with an ISS>15, indicating major trauma, are not identified by the MTTT. This results in many patients with significant TBI being undertriaged and not receiving definitive care as rapidly as possible. Early intervention in patients suffering TBI is essential in ensuring the best possible outcome. A retrospective clinical record review is being conducted to establish whether there are clinical or behavioural indicators of TBI that could be incorporated into clinical guidance to improve identification. ⋯ This retrospective clinical record review could greatly improve the identification of major trauma patients who have sustained a serious head injury. In turn this will mean more patients being appropriately conveyed to the MTC where specialised neurosurgeons are available.
-
Some ambulance services in the UK use the Medical Priority Dispatch System (MPDS) to triage 999 calls and determine the response allocated to patients. When MPDS was developed in the 1970s Sickle Cell Disease (SCD) was not common in the UK and was therefore not included in the system. As ethnic diversity in the UK increased so did the prevalence of SCD, yet ambulance services were still unable to identify this group of patients and assess their specific needs. Patients with SCD usually contact the ambulance service when they experience a Sickle Cell Crisis (SCC), which is characterised by severe pain. It is important ambulances arrive quickly to allow patients' pain to be managed in a timely manner. However, not having a way to identify these patients at the time of the 999 call means that patients potentially receives variable responses. ⋯ The over-ride resulted in a quicker ambulance response which reduced the chances of the patient's condition worsening before the arrival of an ambulance. This project also provided evidence and allowed for the SCC override to be adopted nationally.