How are handover delays from ambulances to emergency departments being addressed in the United Kingdom? A nationwide survey of ambulance services and emergency departments

Excessive waiting times and ambulance handover delays are of high concern to healthcare professionals and the public internationally. Ambulance services and emergency departments (EDs) have attempted to mitigate delays but the initiatives implemented have not been systematically described. To inform site selection for a national evaluation of such initiatives (the STALLED study), we set out to identify and describe initiatives that have been implemented at the ED entrance to address delayed ambulance handover in the United Kingdom (UK). Survey of current practice in all UK ambulance services (a total of 13) using a semi-structured questionnaire, distributed by email, focusing on initiatives based at the door of emergency departments, for completion and return by email or telephone interview. We also sent the questionnaire to a purposive sample of 24 EDs, identified from ambulance service responses. We summarised and coded initiatives reported and mapped them to the Systems Engineering Initiative for Patient Safety model, to support an understanding of where and how those initiatives influenced the healthcare system. Twelve of 13 ambulance services and 16 of 24 EDs responded to the questionnaire describing 34 and 36 initiatives respectively. All respondents reported having several (between two and 12 per service) initiatives in place to reduce handover delays, most commonly involving ambulance staff caring for groups of patients in ED corridors (8/12), coordinated patient handovers within a defined time period (7/12), and ED reconfiguration to facilitate rapid offload (10/16). Most initiatives focussed on changes which influenced the organisation of care, the introduction or revision of key tasks and roles for staff, as well as changes to the ED environment. Ambulance services and EDs have implemented a variety of initiatives to reduce handover delays. Most of the initiatives involve multiple parts of the system, including tasks, staff, the organisation and the internal environment. These complex initiatives require careful study to understand how they work and how they can inform best practice.