Patient Story - September 2024
Meeting: Public Board
Date: 11 September 2024
Report Title: Patient story – Julian Hammond
Agenda Item: PUB24/9/1.4
Author: Rachel Morris, Head of Patient Experience
Lead Director: Simon Chase, Chief Paramedic and Director of Quality
Purpose: Discussion/review
Link to Strategic Objective:
- Provide outstanding quality of care and performance
Link to strategic risk(s):
- SR2: If we do not deliver operational and clinical standards then there is a risk of poor patient outcomes and experience
- SR3: If we do not ensure we have the ability to plan, influence and deliver across our systems to secure change, we will not be able to meet the needs of our public and communities
Equality impact assessment: No negative impact identified
Previously considered by: Patient and Public Involvement Team
Recommendation: Review and discuss the impact of delays to patient experience and discuss the actions underway to improve and reduce delays in providing a timely response.
Purpose: To consider how we can improve patients’ experiences of handover delays.
Executive summary
Patient Story from Mr Julian Hammond, who was conveyed after a vasovagal syncope (fainting episode). A handover delay lead to Mr Hammond being co-horted outside the hospital prior to admission. Mr Hammond’s experience of this handover delay was positive due to the care and consideration provided by the crews, but the time taken to off-load him from the ambulance crew was lengthy, preventing them from responding to waiting emergency calls. The paper details other projects working to improve patient experience and safety during handover delays which remain of concern around performance and patient safety and experience.
Introduction/Background
As a service we have a target for handover delays in terms of hours lost, and we tend to think about them in operational terms; the hours lost and the patients not responded to. We primarily view handover delays in terms of risk. Whilst this is the most important consideration for the service and for managing risk in the community, we shouldn’t forget the impact of the patient experience of handover delays.
At arrival at the Emergency Department, crews will be awaiting input from the hospital staff and cannot control the length of time this takes or the input received from the hospital during this wait. Most of the patients’ experience of handover delays is with our crews in our ambulance; this means that a lot of the things that are important to their experience do remain partly within our control.
This patient story is about the experience of Julian Hammond who, on waking in his armchair with a numb right leg, fell over when attempting to stand. He tried to get off the floor and fainted for a couple of minutes, followed by vomiting once he regained consciousness. His wife called 999, and the ambulance arrived to complete their assessment and decision-making within an appropriate C2 timeframe.
After carrying out a full assessment, the crew could not establish what had caused Julian’s syncope (faint) and decided to convey him to hospital for further investigation. Julian did not find the journey in the ambulance very comfortable which caused him to vomit once again. There were delays at the hospital and Julian subsequently remained in the care of the ambulance service. Julian explains that the crew’s shift had finished so his care was transferred to a second crew who remained with him until there was space for him in the A&E department.
Once in A&E, he had investigations including a CT scan and ultrasound which both came back clear. He was advised by doctors that they thought he had had a vasovagal syncope (faint) caused by restricting the blood flow to his leg whilst he was asleep. When he tried to quickly stand the blood rushed to his leg starving his brain of oxygen and reducing his blood pressure.
Overall, the patient has nothing but praise for the ambulance service: they treated him well and looked after him whilst he was waiting in the ambulance, but he understood their frustration in not being able to off-load a timely manner
Key Issues/Risks
Mr Hammond specifically identified feeling well looked after, the crew communicating with him and having his basic needs met as things that were positive about his experience. These things are all within the control of our crews to provide. Mr Hammond’s story links to wider issues that we are considering regarding handover delays as we approach Winter pressures as, unfortunately, not all patients have similarly positive experiences.
The National Ambulance Service Patient Experience Group (NASPEG) is currently undertaking a snapshot of patient experience of handover delays on a scheduled date of 17 October 2024. All Trusts will attend two A&E departments to gather information from patients in real time about their experience. This will be collated into one document for QIGARD (Association of Ambulance Chief Executives Sub-group around Quality and Risk) with the aim of establishing insight into patient experience of handover delays and how we can improve this.
This will also provide EEAST with an understanding of what our patient experience of handover delays are, whether crews are communicating well with our patients, whether they are appropriately monitoring patients and whether they are meeting patients’ basic needs. With this information, we will know what actions we need to take to improve our patients’ experiences in this situation.
From a patient safety and a patient experience perspective, we know that there have been occasions where patients have deteriorated whilst in the care of our crews, while still in situ in the ambulance. In some of these recent incidents discussed at the Incident Review Panel, ambulance staff had not always undertaken observations of the patient during the delay.
As a result, a pilot is being established at the James Paget Hospital between patient safety, patient experience and the operational leadership in Norfolk and Waveney to monitor and report whether best practice guidance is being followed during handover delays in relation to hospital staff attending to assess patients, and ambulance staff completing regular observations. The aim of this is to ensure that more consistent care is being provided to patients during delays and to improve the safety and overall patient experience.
Furthermore, the Trust, with the support of the regional Medical Directors, is working towards a ‘withdraw in 45-minutes process’ and the projects detailed in this paper are designed to complementthis and improve safety and experience within those 45-minutes, and to improve accountability and safety on occasions where handover may for any reason take longer than this.
Options
For information and discussion only at this stage.
