I have been on four night this week and along with the normal clinical incidents, staffing and fleet issues, the main focus of the week has been dealing with hospital handover delays.
As you have probably seen in the press this is a country wide problem with very few hospitals not experiencing some sort of delays. Within East Dorset we have two acute hospitals and both have had delays all week.
As I am sure you understand hospitals have a set number of beds (capacity) this can be added to by using what are known as escalation or winter pressure beds. Capacity can be affected by a variety of factors such as weather, time of year, local factors or acuity of patients.
So lets look at Mrs Miggins ( the well known ambulance patient and pie shoppe owner ) journey from 999 call to discharge.
Mrs Miggins rings 999 at 1430 on a Monday afternoon. Her call is answered by a call taker in the clinical hub and the Pathways triage tool is used to determine the response needed. It is decided that she will need an ambulance to assess and probably transport her to the local hospital.
The ambulance is dispatched and the after a clinical assessment decide that Mrs Miggins will indeed need to be sen at the local hospital.
Once at the hospital the crew complete a handover and Mrs Miggins is transferred on to a hospital bed. She is then undergoes a examination by the Emergency Department doctor. His finding show that Mrs Miggins will need to be admitted to a ward. The bed manager is contacted, a bed on a ward is arranged. She is then moved to the ward where she is a inpatient for 3 days. Once her condition has been stabilised and she is ready for discharge the discharge team are asked to arrange a package of care to be put in place to support Mrs Miggins for the first week or so once discharged from hospital. Once all this is in place transport is arranged to return Mrs Miggins home.
As you can see the Journey involves a large number of steps all reliant on one another. Recently ambulance services were experiencing 20% increases in demand so this may have delayed Mrs Miggins arriving at hospital. The ED department may be full and the crew not able to off load. Once seen and a clinical decision made there may not be capacity in the hospital so a transfer to the ward may be delayed. Once fit for discharge if social care in the community is needed it can take time to organise and community beds in hospitals or care facilities can take longer. At every stage of the process a delay can be introduced which can affect patient care and outcome.
Up and down the country health care staff work tirelessly on a daily basis to ensure that the patient journey is a smooth and problem free as possible and I for one am proud to be part of that team. the system is not perfect but but our local management team work with both acute hospital to reduce handover delays. This is both by changing the handover process so that it works better on a daily basis as well as supporting the hospitals during acute periods.
So what can you do to help to reduce delays? There are many people you can contact before ringing 999 or attending a Emergency department.
Please think before calling 999 or attending an Emergency Department.
Finally a thank you to all the staff working hard to ensure patients receive the treatment they need in a timely manner across the country.
Mrs Miggins went home and the Pie Shoppe is open as usual.
Stay safe.
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