Four in five ambulance patients brought directly to ED, report finds

Too many ambulance patients are being transported straight to an emergency department (ED) and too many are being brought there on the flat of their backs, according to an official report.

Four out of every five ambulance patients are brought directly to an ED, compared to half in the best-performing ambulances services in the UK, the report by a Health Service Executive panel notes.

This suggests “a higher propensity to convey patients directly to EDs” rather than paramedics first assessing them and deciding on the most appropriate care pathway.

The report says fewer patients should be brought into hospital on an ambulance trolley bed, as many are “fit to sit” when being brought to the ED. Avoiding the use of trolleys for such patients can “expedite investigations and facilitate discharge assessments”.

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Delays in handing over the care of patients arriving by ambulance to hospitals are largely a symptom of the pressure on the system, according to the report, but not all delayed handovers are due to capacity issues.

ED and ambulance staff need to prioritise more the risks to patients left waiting in ambulances on arrival at hospital, the report says.

Trolley beds

The large majority of patients arriving at ED by ambulance are brought in on a trolley bed, it adds. While this may be clinically appropriate, “not everyone who presents on an ambulance trolley needs to remain on the trolley whilst awaiting the transfer of care or indeed require transfer to a hospital trolley within the department”.

The report notes a “worrying” trend of patients arriving at ED by ambulance but not being able to access the department. Paramedics then have to care for the patients in the back of the ambulances “for significant periods of time”.

“These circumstances present considerable patient safety concerns. It also means that patients have limited access to toilet facilities, heat, food and water. This practice is also resulting in a deterioration in relationships between acute hospital staff and frontline crews.”

ED doctors interviewed for the report expressed concern over blockages caused by “sudden influxes” of patients, often when they have been the subject of a home visit earlier in the day and are then brought to hospital by ambulance in the afternoon.

The report is critical of a lack of 24/7 cover by operational managers in the national ambulance service, which is "at odds" with arrangements in England, Scotland and Wales.

Internal HSE records show the time it takes to hand over a patient from ambulance service to an ED is continuing to deteriorate, to the point that it is impacting on the ability to the respond to 999 calls.

The arrival to handover time increased from 44 minutes in July 2021 to 65 minutes in September 2021 and stood at 58 minutes last February.