Paramedics have begun looking after patients inside an A&E unit, in an initiative by the health service to stop ambulances queueing outside hospitals and ease the strain on overstretched casualty staff.
The scheme has led to patients being handed over much more quickly at a hospital that was one of the worst in England for sick people being stuck, sometimes for many hours, in the back of an ambulance.
Queen’s hospital in Romford, in east London, has set up an ambulance receiving centre (ARC) near its main casualty unit in which two London Ambulance Service paramedics are on duty round the clock to help look after patients who would otherwise be trapped outside or in a corridor, waiting to be seen.
Patients who end up in the new six-cubicle unit behind the A&E nurses’ station 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 nearly 13,000 hours of ambulance crews’ time and enabling them to respond to emergency calls more quickly.
Some A&E doctors regard the scheme as merely “a sticking plaster”, given that queues of ambulances have become common outside many hospitals and that casualty units are treating the lowest percentage of patients within four hours on record.
Matthew Trainer, chief executive of the Barking, Havering and Redbridge trust, which runs Queen’s, admits that “we still have far too many handover delays”. But, he pointed out, the ARC has also led to a big improvement in the hospital’s previously dire 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. However, over the same period the proportion who had to wait at least an hour to be handed over fell from 27.4% to 19.4%, Trainer added.
Last Wednesday afternoon all six cubicles were full, mainly with older people who had fallen or suffered a flare-up of an existing illness. However, there were no ambulances outside waiting to offload a patient.
In cubicle four of the ARC, 71-year-old Makhan Singh was happy. He had been triaged quickly and given antibiotics for his stubborn cough and a battery of tests to help doctors assess him. “This setup is good. It’s better than waiting in A&E, which was my main worry coming in today,” he said.
Daniel Elkeles, chief executive of London Ambulance Service (LAS), said: “The ARC means that patients benefit, the ambulance service benefits and people waiting for a response to a 999 call 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 to Romford to see how it works.
However, not everyone is impressed. The Royal College of Emergency Medicine, which represents casualty doctors, branded the ARC “short-sighted”. Katherine Henderson, the college’s president, said: “Pre-emergency department handover models are not recommended by RCEM. Instead of focusing on demand management on the front door, we must look at solutions around flow and discharge [of hospital patients].”
She likened the scheme to NHS England’s plan, floated in March but never implemented, for patients to be treated in tents in hospital car parks, to relieve the strain. “Not only did these make no difference, but they were impossible to man with staff, and presented serious safety risks. The initiative was just corridor care under a different name.”
Improving social care, to free up beds by enabling the speedier discharge of older patients who are medically fit to leave but need support afterwards, would do more than anything else to end the long queues, Henderson added. “Shortsighted ‘temporary’ solutions do nothing to tackle 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 reducing hospital handover delays at emergency departments.
“Resolving unnecessary delays – and the consequent effects these have on ambulance service performance times, wellbeing of staff and harm to patients – is the primary action that can be taken to relieve 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 official in the ambulance sector said that while the 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 at every hospital but staffed entirely by A&E personnel, so all paramedics can leave as soon as a handover is complete.
