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Patient ‘waited over 19 hours’ outside emergency department in Worcestershire

Patients are at increased risk of pressure injuries from lying for long periods on ambulance trolleys due to handover delays in hospitals, a CQC report has found.


During an inspection of the Worcestershire Health and Care system from November 21-23 last year the regulatory body reported delayed ambulance response times and unmet handover targets which reflected national trends.

It also reveals hours lost due to a delayed handover increased from 6,000 to 33,000 per month between April 2019 and March 2022.

On one of the inspection days one patient waited for more than 19 hours outside the emergency department and the average wait time was 6.5 hours.

The report reads: “Lengthy delays at hospitals increased risk to patients, particularly those that had been lying on trolleys or stretchers in ambulances, for longer periods.

“It was unclear who was responsible for the personal care of patients whilst waiting in the ambulance.

“Ambulance staff were not trained in personal care or to use some personal care equipment, even though they performed these tasks.”

But West Midlands Ambulance Service (WMAS) has raised concerns with the CQC around recommendations that it should provide more comfortable mattresses and patient care and nutrition.

However, these concerns have been rejected by the CQC.

The WMAS board discussed the inspection report at its most recent meeting, where Strategy and Engagement Director Vivek Khashu presented the item.

He said: “We shouldn’t be training our ambulance staff to be nurses or care assistants in that regard.

“And of course, while our ambulances are at hospital looking after patients, invariably there’ll be a queue of the waiting emergencies waiting for an ambulance to respond.

“So it’s the right observation because clearly patients personal care needs do need to be met; clearly their nutritional needs need to be met.

“So the observation from CQC is absolutely right, but as to who’s responsible for doing that, well, we think that’s another matter.

“We believe that once patients arrive at hospital they are the responsibility of the hospital in terms of looking after the entire need.”

On the recommendation that WMAS provide mattresses more suited to longer term use, he added: “We just don’t think that’s the right response to a very real issue.

“The heart of this is patient flow.

“The heart of this is getting handovers of patients enacted, not building in processes around the failure of patient flow and the inability to get patients into the right place.”

The CQC is undertaking inspections of urgent and emergency care services during a time of sustained pressure but these do not include giving new ratings.

Currently, WMAS is rated as outstanding overall with safety rated as good and all other key questions as outstanding.

Positive outcomes were also identified at this inspection, including approaches to hygiene, patient safety, good communication and treating patients with compassion.

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