Delayed transfer to Accident & Emergency causing harm9 Nov 2022 | Tahsin Choudhury
The Healthcare Safety Investigation Branch (HSIB) has identified that patients may come at risk of harm whilst waiting in ambulances for appropriate care at hospitals.
Emergency departments at hospitals are often running at full capacity, and it has been noted that some patients have had to be assessed in the back of ambulances because of this. Delays in transferring patients from an ambulance to an emergency department are causing a knock-on effect on ambulance response times. A lack of timely and appropriate treatment can lead to the decline of some patient’s health or sadly even death.
The investigation focused on the healthcare system as a whole and how each department can facilitate the flow of patients between areas. Managing this flow will significantly impact a patient’s care, especially in ensuring that a patient is cared for in the right area. For example, it was found that many diabetic patients were being treated in the wrong wards. This may be detrimental to treatment if the ward staff do not know a patient’s diabetic care plan or have limited experience in nursing /caring for diabetic patients.
The HSIB identified an “air gap”, when a patient is moved between departments and is not properly managed in the correct direction, causing a higher risk of harm. This lack of guidance was particularly apparent in the handover between healthcare to social care providers, such as local authority care homes. For example, if a care home is not equipped to receive a patient on the weekend, the same patient will likely need readmission shortly after discharge. This is detrimental to the patient and has an adverse effect on the flow of patients in hospitals. Care homes may not be able to take patients discharged from the hospital, and the hospital may have to keep the patient in a hospital bed for a longer period than anticipated, which can result in adverse medical issues such as pressure sores or developing infections in the hospital.
To combat this, it is suggested that a deeper relationship between health and social care workers will make a real difference despite a formal one already in its early stages. The system was more likely to work better with stronger interpersonal bonds between the two. Implementing a “whole system” attitude across the board will likely encourage this and enable communication. Ambulances are also trying to take only the patients that need to attend hospital in ambulances to try and increase their capacity and assist the emergency departments, whilst hospitals try to increase their bed capacity.
It would seem that the ambulance service is buckling under the pressure put on them, preventing the ambulance crew from effectively carrying out their duties safely and efficiently. This must surely cause anxiety and stress for those working in the ambulance service and patients who rely on their care.
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