Ambulance handover delays
The national guidance states that patients arriving at an emergency department by ambulance must be handed over to the care of A&E staff within 15 minutes. A handover delay does not necessarily mean that the patient waited in the ambulance, they may have been moved into the A&E department but staff were not available to complete the handover.
This is regarded as one of the most important indicators of a system under pressure, as it occurs as a result of a mismatch between A&E/hospital capacity and the number of elective or emergency patients arriving. In advance of A&E departments becoming so full that significant queuing begins, hospitals should implement the full escalation plan and alert the local clinical commissioning group. If a significant delay still occurs, it demonstrates a failure of the hospital trust (and wider health community) to meet the needs of patients requiring emergency admission to hospital, as allowing ambulance queues to build up is not an appropriate way of managing an increase in demand.
Data on ambulance handover delays of over 30 minutes is collected as part of daily SITREPs. The 30 minutes includes the 15 minutes allowed under SITREP guidance if an ambulance is unable to unload a patient immediately on arrival at A&E because the A&E is full.
The start time of the handover is defined as the ambulance's time of arrival at the A&E department. The end time of the handover is defined as the time of handover of the patient to the care of A&E staff.
All accident, emergency and urgent patients destined for A&E (either Type 1, 2 or 3) are counted. This includes GP urgent patients brought by ambulance to A&E. Non-emergency patients are NOT counted. Patients being transported between locations/trusts/hospitals (e.g. for outpatient clinics, tertiary care) are not counted. Ambulance trusts do not count the time required for crews to complete record forms, clean vehicles, re-stock vehicles or have a break.
The ISO week date sytem was used - each week begins on a Monday and the first week of the year is the first week when the Thursday falls in the new year. For example, if January 1st fell on a Friday, Week 1 would start the following Monday. The average of Weeks 51 and 52 were calculated for analysis purposes, as there is much variation depending on when Christmas and New Year falls in that particular year.
For more information, please see NHS England's Winter Daily Situation Reports.