youhere is a hallway in my local hospital that looks very familiar to me. It goes from the ambulance entrance to the initial evaluation area in A&E. Patients sit in a row on clean chairs under banners about hand hygiene and mask wearing. I think of this corridor as the twilight zone, a place where time evaporates, because this is where ambulance crews now wait for hours, day and night, Monday through Sunday, with their patients on carts to be called to the department. of emergencies. on.
The news that ambulance crews are experiencing hospital delays up to 40 hours is impressive. Every year we hear about the latest challenges facing the NHS, but these problems are now so commonplace that they feel routine. We used to talk about winter pressures, but those pressures now seem to be year-round. When I started in the ambulance service over a decade ago, I expected to see nine patients in a shift, taking travel, assessment, treatment and delivery times into account; now that figure is more likely to be six, on a good day.
The consequences for patients are clear: physical discomfort, emotional distress, and potential for impairment. Critically ill patients are brought to the hospital with blue lights and pre-alert to ensure they are seen immediately, but there are many with conditions that are not life-threatening for those waiting in the hallway or in the back of an ambulance. , it will have insidious consequences, such as a delayed recovery. The reality is that these same patients have likely experienced long waits for the ambulance to arrive in the first place, because delayed crews in hospital corridors mean fewer resources available to respond.
It is sometimes suggested that ambulances should be able to unload their patients at an intermediate monitoring zone while they wait to access A&E. This strategy is used in some hospitals and has the benefit of freeing up ambulances to become available again, but it effectively creates another cohort of patients waiting to be seen, without additional staff, and when the ambulance crew returns with their next patient, the same problem is repeated.
In some areas, ambulances are instructed to take patients to quieter hospitals to improve flow: the theory is to spread demand and reduce wait times, though the system tends to be unpopular with patients, who may end up being taken to places far from home. For traveling ambulance crews, such measures feel like well-intentioned adjustments, rather than a genuine attempt to address the core problem: lack of capacity.
There are some causes for optimism. Since the pandemic, doctors from different areas of the health service have become more familiar with each other’s roles, meaning it is now easier for ambulance teams to refer their patients to primary care services and avoid hospital admissions. unnecessary. Alongside this, new clinical pathways have developed, such as same-day emergency care services, which filter appropriate patients away from A&E and toward specific clinics. Sometimes it takes time for the benefits of such changes to become apparent.
Recent reports have highlighted the impact of late discharge. The temptation is to conclude that patients should be packed up and discharged as soon as they are fit, but the scale of this undertaking only becomes clear when seeing patients in the community. This week I attended to an elderly woman who had been discharged to her house after a fall and operated on for a hip fracture. However, the necessary support and equipment had not been arranged prior to discharge and as a result the patient, who lived alone, ended up being readmitted to the hospital until proper arrangements could be made.
With the government recently announcing an injection of download funds for hospitals in England, it is worth remembering that the social situation to which a patient is discharged is often the same as that which led to a hospital admission in the first place.
The emergency health system can be a victim of its own accessibility. Ambulance services in England have accepted the increase in low acuity calls they are receiving and now operate as both emergency and urgent care providers, taking only 51% of patients to the emergency room in October, resolving 33% of incidents at the scene and 12% by telephone. Emergency departments have experienced similar behavior changes, with 24.4 million emergency visits in England in the year 2021-22, and 47% of those attendances by people under 35 years of age.
Many patients now choose to self-report to A&E rather than go to their GP, perhaps due to problems getting an appointment, perhaps due to a lack of knowledge of available services, perhaps for simple convenience. But just as ambulance services now struggle to meet the needs of your sickest patients With patients encroaching on the ER system with minor complaints, it’s easy to see why understaffed A&Es are struggling to keep up with demand.
As the National Health Service As we prepare to face an exceptionally challenging winter, it is incumbent on those in power to ensure that such vital services are adequately funded and that doctors are adequately supported, so that patients are not left waiting in the twilight zone.
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Jake Jones is the pen name of a paramedic and the author of Can You Hear Me? An NHS paramedic’s encounters with life and death
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