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Review of Patient Safety, Privacy, Dignity and Experience whilst Waiting in Ambulances during Delayed Handover

Positive patient experience of ambulance crews but handover delays and variations in process hinder the provision of responsive, safe and dignified care.

Healthcare Inspectorate Wales (HIW) has today [7 October] published the findings from its β€˜Review of Patient Safety, Privacy, Dignity and Experience whilst Waiting in Ambulances during Delayed Handover’.

Our review found that the issue of prolonged handover delays is a regular occurrence outside Emergency Departments (EDs) across Wales. It is clear that these delays and variations in process between and within health boards are having a detrimental impact upon the ability of the healthcare system to provide responsive, safe, and dignified care to patients. Despite this, patients were generally positive about their experiences of ambulance crews, particularly in relation to their kindness, communication and management of situations.

Whilst there are clear expectations and guidance for NHS Wales to follow, and a clear will to meet these guidelines, there are substantial challenges which inhibit efforts to consistently achieve these. Whilst handover processes at EDs across Wales were broadly similar, we found many examples of these processes being adapted for a range of reasons including departmental layouts, differences in staff roles and availability of staff. We found day to day inconsistencies within the same department and sometimes between clinicians and ED staff as well as a lack of clarity between the Welsh Ambulance Services NHS Trust (WAST) and ED staff about responsibility for a patient until transfer to the ED. These types of inconsistency can introduce risk and have a detrimental impact on patient care and safety and therefore requires attention.

We found that new roles had been introduced by some health boards aimed at improving handover processes, however, these roles are not in place across all EDs, and we believe that all health boards should consider the benefits that these roles may bring.

A significant amount of work is already underway across NHS Wales to tackle these issues. However, it is clear that more improvement work is needed between WAST, health boards and Welsh Government to meet these challenges. We have encouraged this by requesting a joint response to the recommendations within our review.

Alun Jones, Interim Chief Executive of Healthcare Inspectorate Wales said:

β€œIt is clear that the dedication and commitment of WAST and ED staff has continued to result in positive patient experiences despite the challenges of the pandemic. There is however, significant collaborative work needed to resolve the issue of prolonged handover delays which are a symptom of wider patient flow issues throughout the NHS in Wales. It is my expectation that the recommendations that fall from this review are taken forward alongside, and in the context of, other work in this area to achieve the required improvement.”

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