Shropshire hospital patient in four-and-a-half hour A&E ambulance wait

A patient was forced to wait during an ambulance handover to a hospital A&E department of more than four-and-a-half hours, figures released today reveal.

Ambulances stock

Figures show that the longest delay was four hours and 31 minutes outside Royal Shrewsbury Hospital and three hours and one minute outside Telford’s Princess Royal Hospital.

The average time for a crew to complete a patient handover and be ready to respond to the next call at PRH was 34 minutes and 42 minutes at RSH.

National targets state that patient handovers should be completed within 15 minutes of arrival at a hospital and the vehicle must be ready to respond to the next call 15 minutes after.

The delays being experienced by paramedics will be discussed at a Shropshire Council health and adult social care scrutiny committee meeting in Shrewsbury on Monday.

Claire Brown, of West Midlands Ambulance Service, said: “Shrewsbury and Telford Hospital NHS Trust accounts for over a quarter of all hospital handover delays we experience across the West Midlands region.

“Like our own staff, the team in the hospital are working incredibly hard to provide the very highest standards of patient care despite the unprecedented level of demand which both organisations are experiencing.

“Only around a third of patients attending A&E arrive by ambulance so at times of peak demand, handover delays do occur.

“Every time one of our crews is delayed, it has a significant knock-on effect on our ability to respond to 999 calls in a timely manner, which puts patients at risk.

“We will continue to work closely with the acute trust to improve the handover times.”

Hospital bosses have admitted there are problems with patient handovers from ambulances, with rocketing attendances at A&E blamed.

Debbie Kadum, of the Shrewsbury and Telford NHS Trust, said: “We completely accept that, in terms of patient handover, we are not in the place that we want to be.

“The NHS, both nationally and locally, continues to see a big increase in demand. About 50 per cent of patients brought into our emergency departments by ambulance need to be admitted for further care.

“We’re working to ensure the remaining patients who don’t need to be admitted are taken to the most appropriate place to be seen or treated.

“This is an issue not just for us at SaTH, or for our partners in the ambulance services, but for the whole health economy.”

Meanwhile Shropshire’s A&E departments are still struggling to meet targets.

Pressure on bed places in both PRH and RSH has led to patients being cared for in places like corridors.

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Comments for: "Shropshire hospital patient in four-and-a-half hour A&E ambulance wait"

johnfrederick

Just wait untill we get Future Fit ?

Roger

So again this has nothing to do with patients walking into A&E. These are patients who have been attended by the ambulance service, who have been triaged by the ambulance service as in need of hospital attention.

On arrival at hospital they will triaged again with all patients seen in priority order. In Shrewsbury they would go straight to the major Injuries unit from where they could be down graded to minor injuries and put to sit in the waiting room for their turn. Ambulance released. So the hold up in the Major injuries unit is not having a cubicle to put them in. That is either because people are occupying the cubicles awaiting treatment or transfer to a ward. That has nothing to do with people walking in the front door of the minor injuries unit who either get sent to the walk in GP or Minor injuries. They are all seated, no need for ambulances to be detained.

All of this delay is in the part of A&E that the public never reaches before triage. All the trivia will be sat waiting. So this bed blocking, lack of cubicles or lack of staff to process serious injuries. The general public can have no influence on the situation and no matter how many walk through the front door it can not effect this separate route through A&E.

What is clear is that there is no case to close the major injuries unit in either hospital before positive action is taken to correct the situation by the NHS. With the walk in GPs all closing in Telford the management of urgent care is going to be out of control. Urgent is not necessarily severe. It could be just pain killers or reassurance that the bone is not broken . It might not seem important to the NHS but is vitally important to patient. They had an additional 8 cubicles added at the PRH and that does not seem to have made any difference.

I therefore conclude that this a case under-manning in the A&Es which is all to do with recruitment and retention. The is surely an NHS problem that starts with the number of University places for Medical students being insufficient to meet the demands of the NHS. Failure to recruit from overseas to fill the gap and the influence on Doctors choices of where they want to work when they qualify. What we are looking at is the consequences of failure years ago to have enough student places and currently how Doctors operate their career options given the dreadful way junior doctors have been treated. These are situations not entirely in the control of the NHS because they are influenced and controlled by politicians.

To find the roots of this problem we need to go back ten years and follow the progression and numbers of students being admitted to medical courses and if there was enough them, how have the number changed and at what point have potential NHS doctors dropped out of the process. Analysis of the reasons for the shortage of staff and take corrective action. That will fix the long term problem but the shorter term problem is about why people dropped out and what will bring them back.

More short term problem solving is not so assured. Routing patients to Nurse practitioners, better use of walk in GPs, more aggressive triage which actually turns away patients from A&E to other alternatives provided they are available. A matter of putting patients into the correct work streams. That starts with the acceptance by the NHS that patients are not the best people to decide which work stream they should be in Most patients want to be told what they need to do to address their urgent need. Then the system needs to be able to address the needs. That means an appointment with the GP seven days a week on a walk in basis. In Shrewsbury that means go to A&E to see the walk in GP in hours or Shrop doc out of hours. In Telford it is up to the CCG to organise continuous access to replace the Walk ins. It means the triage nurse in A&E must have available options outside the Hospital. The key word is "AVAILABLE" that is what the patient needs. Otherwise A&E is the safety net to catch all other NHS failures. Ideally 111, A&E, ambulances, Walk in GPs and Shrop doc and dispensary all located in the Urgent care centre with options to to go to the patients home 24 hours a day 365 days. That works for the community hospital UCCs with a further option to transport the patient to where the treatment is available. It would also work for the big health centres like the health village.

The point being that the patient enters the NHS at any of the nominated points from which the NHS takes over decision making and transportation if required. The patients urgent need is addressed.

firebird

OUR NHS will not improve all the time we have this type of TORY government, who demonstrably only govern, and indeed care for the well heeled residing in London, and the South East, what kind of people vote in favour of cutting £30 a week from our sick and disabled, and then award millionaires a tax cut.

firebird

Dozens of accident and emergency units are facing closure or being downgraded in a far-reaching overhaul of urgent care which senior doctors warn would have “disastrous” consequences for the NHS.

An analysis of documents drawn up to remodel the health service in England shows that 24 casualty units from Durham to Somerset have been marked for potential closure despite record demand for A&Es and serious overcrowding across the country as the NHS goes through its most severe winter crisis since records began. Last month produced the worst performance for A&E waits in 13 years.

jhb

jhb

remember chaps that The NHS is safe in our hands - David Cameron campaigning during the last election.

jhb

jhb

What happened to David Cameron's promise The NHS is safe in our hands?