Comment

Accepting responsibilities during handovers

Getting the balance right during emergency department handovers can often be challenging, but knowing who is responsible for each patient could improve safety massively writes Jacqueline Price.

We have all seen the headlines about ambulance crews spending hours waiting to take patients into too full emergency departments (EDs). We know there is an issue of safety when patients are handed over, and there is not an infinite supply of space or skilled ED staff to care for them.

A stalemate ensues: one part of the NHS refuses, for understandable reasons, to accept responsibility for arriving patients, while another part cannot provide a timely service to patients with potentially life-threatening conditions because they are parked up outside.

Holding

I was on an emergency transfer in the early hours of the morning some weeks ago and had to accompany the paramedic crew to the local ED. On arrival we were directed to wait in between the external and internal doors for a trolley to become vacant. I was told that

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We have all seen the headlines about ambulance crews spending hours waiting to take patients into ‘too full’ emergency departments (EDs). We know there is an issue of safety when patients are handed over, and there is not an infinite supply of space or skilled ED staff to care for them.


Picture: Alamy

A stalemate ensues: one part of the NHS refuses, for understandable reasons, to accept responsibility for arriving patients, while another part cannot provide a timely service to patients with potentially life-threatening conditions because they are parked up outside.

Holding

I was on an emergency transfer in the early hours of the morning some weeks ago and had to accompany the paramedic crew to the local ED. On arrival we were directed to wait in between the external and internal doors for a trolley to become vacant. I was told that up to three patients are often ‘held’ in this small space. If any more arrive they are returned to the ambulance until there is a space in the queue.

The dynamics of providing ongoing care to patients while being ‘held’ are severely testing. Patients and their families experience high levels of anxiety while waiting, and maintaining privacy and dignity is challenging.

'A resolution to the situation seems unattainable'

In addition, professional respect between nurses and paramedics risks being undermined. I cannot help feeling that by diverting the problem back to the ambulance service so that ED nurses and other health professionals cannot ‘see’ the problem, the impetus for finding ways to improve transitions into and out of the ED is severely diminished. 

Although there appear to be endless high-level discussions, debates, escalations and all manner of acknowledgements of the problem, a resolution to the situation seems unattainable.

Advocating

ED nurses and paramedics need to be actively engaged in these conversations, advocating for patients and articulating the professional anxiety and impotence the current arrangements create. 


About the author

Jacqueline Price is principal lecturer and lead for adult and primary healthcare CPD at the University of Hertfordshire. She is also a member of the RCN Emergency Care Association

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