What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Our proposal involves both ambulance and acute hospital trusts supported by the wider North East London (NEL) Integrated Care System.

Currently ambulance handovers routinely breach the national standard of 15 minutes, often resulting in 30, 45 or 60+ minute handover breaches. Our proposal sets out to sustainably reduce handover wait times, ensuring equity for all patients.

The proposal plans to increase both ambulance and hospital productivity with the potential to significantly reduce handover breaches, lost hours waiting to handover and improve ED wait times.

Improving handover times and associated ED flow provides the opportunity to change and improve the culture between both organisations, supporting our local NEL structure, increasing the capabilities of the respective teams to learn and build in further improvements.

This will ensure improvement is embedded into both Trusts and their respective management systems and processes working across the interface of both organisations and the wider ICS.

What does your project aim to achieve?

Ambulance handovers consist of two key elements;

·       Clinical Handover  (ambulance clinician provides a brief handover to the triaging hospital staff)

·       Patient Handover (where the ambulance crew transfer their patient to a designated hospital space, which completes the handover process, the crew are available to attend the next patient waiting in the community.

Clinical Handover is often delayed despite there being a potential opportunity to complete this on arrival, often the delay can simply happen as there may be limited space or perceived lack of space to allow Patient Handover to be completed. Delaying Clinical Handover delays forward planning of the patient’s pathway. Such delays leave little time to prepare for Patient Handover often resulting in a handover breach occurring. The patients becomes the responsibility of the hospital at 15 minutes from arrival irrespective of a handover being completed.

How will the project be delivered?

NEL ICS, clinical and operational hospital leads have all been engaged in developing this proposal. The Breach Buster will be a Band 6 hospital staff member who will be dedicated and focussed on the two key elements of the ambulance handover (Clinical Handover and Patient Handover). The Breach Buster role will support their ED colleague taking handovers to ensure the logistics and operational planning for completing handovers is optimised, allowing the Triage clinician to focus on the clinical elements of completing ambulance handovers. The impact will be measured manually alongside electronic time stamps that take place in order to ensure the data is validated and delivers increased productivity and value for money. Historical breach data will be used to benchmark a baseline for improvement, there will be daily and weekly reviews to ensure that all stakeholders can raise any risks or concerns or indeed suggest further modifications and improvements .

How is your project going to share learning?

The impact of this project will be shared across the remaining NEL acute sites to review what elements they can incorporate to further improve ambulance handovers. Once the impact has been reviewed and measured in NEL there is the potential to roll this out to other Sectors in London working with their ICS colleagues on taking this model forward. The model could be further scaled up by promotion through the Association of Ambulance Chief Executives and expansion to other ambulance trusts. National delays in ambulance response times are well documented and the associated risk this presents for patients waiting in the community this model has the potential to therefore improve hospital performance and productivity by reducing breaches, improving ambulance response times and productivity through reducing wait times at hospitals. Most importantly this will improve patient care and provide valuable learning opportunities for other Q members.