Plain English Summary

Background

There has been a problem in the UK and other countries for many years, that at busy times Emergency Departments (ED) become unable to manage the flow of patients. Patients remain in the ambulance, sometimes for several hours. In some areas this practice is rare, in others it is common. When ambulances are queuing, patients are not receiving full ED care and ambulances are unavailable, so there are ‘knock-on’ effects throughout the system. 

Aim and Objectives

We aim to provide evidence about what works to reduce harms related to ambulance queuing. 

Our objectives are to: 

1. Describe what has been published about what works to reduce ambulance queuing and related harms 

2. Identify initiatives in use across the UK to reduce queuing 

3. Identify EDs where ambulance queuing is rare and understand what policies and practices are being used in those hospitals to avoid ambulance queuing 

4. Assess impact of successful queue management on patient flows, safety, experience, health and costs 

5. Predict wider impacts of initiatives on patient flow through emergency care 

6. Produce guidance about what works to reduce delayed handovers 

Methods

We will use a mix of methods to answer our questions. We will look for existing evidence about initiatives to reduce delayed handovers at ED and survey ambulance services (with follow up at EDs) about what initiatives exist within their areas. We will group initiatives into categories of similar types e.g. ED doctors working in delayed ambulances; paramedics working in ED; or use of additional space. We will analyse existing data to identify sites that rarely queue patients and sites that do this more frequently. We will present findings at a stakeholder event where we will agree on criteria for selecting sites to include in more in-depth work. We will then select and collect data from four sites where ambulance queues are rare (Group 1) and four sites where queues are more frequently seen (Group 2). We will carry out work at these sites to understand what makes a difference to their performance. We will compare important patient outcomes between groups, including: death rate, 999 ambulance attendance, conveyance rates to ED, admissions and waiting times. We will send questionnaires to a sample of patients to gather their experiences, quality of life, use of non-NHS services and safety concerns. We will carry out clinical case note reviews to compare safety issues between groups. We will use patient flow data to determine initiatives that may be most beneficial to the NHS. We will conduct interviews with patients to find out more about their experiences. We will interview stakeholders from across the emergency care system, including ED and hospital staff, ambulance clinicians and call takers, healthcare managers and commissioners about their experiences and views. Finally, we will hold stakeholder workshops towards the end of the study to help us interpret findings and make recommendations about how to reduce ambulance queuing. 

Patient and Public Involvement

We have worked with public contributors to develop the proposal and plain English summary and are including them throughout the study as members of the Research Management Group and Study Steering Group. We have recruited PPI contributors for our Public Advisory Panels.

Sharing our Results

We will publicise the results of the research using scientific journals, social and professional media and conferences, in the UK and worldwide. Our findings will be incorporated into guidelines in the future.