Paramedics have begun caring for patients inside an A&E unit, in a health service initiative to stop ambulances queuing outside hospitals and relieve pressure on victims ’staff.
The scheme has caused patients to be delivered much more quickly in a hospital that was one of the worst in England for patients to get stuck, sometimes for many hours, in the back of an ambulance.
Queen’s Hospital in Romford, east London, has set up an ambulance reception center (ARC) near its main accident unit in which two paramedics from the London Ambulance Service are service throughout the day to help care for patients who would otherwise be trapped outside or inside. a corridor, waiting to be seen.
Patients who end up in the new six-cabin unit behind the A&E nursing station have a better experience while waiting and are more comfortable – and safer – because they can have their relatives with them, eat and drink and use the toilet more easily. .
Nearly 2,000 patients have passed through the ARC since it opened last November, saving nearly 13,000 hours of ambulance equipment time and allowing them to respond to emergency calls more quickly.
Some A&E doctors consider the scheme to be simply “a glued plaster,” given that ambulance queues have become commonplace outside many hospitals and that accident units are treating the lowest percentage of patients in four hours recorded.
Matthew Trainer, executive director of the Barking, Havering and Redbridge trust, which runs Queen’s, admits that “we still have too many delays in delivery.” But, he noted, the ARC has also meant a huge improvement in the hitherto difficult hospital transfer times.
The number of people arriving by ambulance at Queen’s A&E rose from 1,529 in February to 1,788 in May. However, during the same period the proportion that has had to wait at least an hour to be delivered has dropped from 27.4% to 19.4%, Trainer added.
Last Wednesday afternoon, the six cubicles were full, mostly with elderly people who had fallen or suffered an outbreak of an existing illness. However, there were no ambulances outside waiting to unload a patient.
Some doctors consider the scheme to be a simple plaster. Photography: PA Images / Alamy
In cubicle four of the ARC, 71-year-old Makhan Singh was happy. He had been quickly picked up and given antibiotics for his stubborn cough and a battery of tests to help doctors assess him. “This setup is good. It’s better than waiting at A&E, which was my main concern to come today,” he said.
Daniel Elkeles, executive director of the London Ambulance Service (LAS), said: “The ARC means that patients benefit, the benefits of the ambulance service and people waiting for an answer to a 999 call as well.”
NHS England leaders believe the partnership could be adopted elsewhere. Whipps Cross Hospital in East London has introduced a similar facility and managers from other NHS trusts have been to Romford to see how it works.
However, not everyone is impressed. The Royal College of Emergency Medicine, which represents injured doctors, called the ARC “short-sighted.” Katherine Henderson, president of the university, said: “Pre-delivery models to the emergency department are not recommended by the RCEM. Instead of focusing on demand management at the front door, we need to look for solutions in the around flow and discharge [of hospital patients]. ”
He compared the scheme to the NHS England plan, launched in March but never implemented, for patients to be treated in tents in hospital car parks, to relieve tension. “These not only made no difference, but were impossible to work with staff and presented serious safety risks. The initiative was just the care of the hallway with a different name.”
Improving social care, to free beds allowing faster discharge of elderly patients who are medically fit to leave but who need support later, would do more than anything else to end long queues, Henderson added. “Temporary‘ short-sighted ’solutions do nothing to deal with the crisis,” he said.
However, Martin Flaherty, managing director of the Association of Ambulance Chief Executives, praised the ARC as “a positive example of what can be achieved when a system-wide approach is taken to reduce delays. delivery of the hospital to the emergency departments.
“Resolving unnecessary delays, and the consequent effects they have on ambulance service performance times, staff well-being, and patient damage, is the main action that can be taken to relieve pressure on the ambulance sector. ambulances and allow us to get back on the road so we can respond to more patients who need our life-saving care, ”he said.
But a senior ambulance official said that while the ARC “is a step in the right direction, it still requires ambulance staff to be present to care for the patient, thus keeping them out of the way. the road to other places “. The ideal, he added, would be an ARC-type facility at all hospitals, but fully customized by A&E staff, so all paramedics can leave as soon as delivery is complete.