Changes at Nottingham hospitals have helped cut ambulance response times for some urgent patients by up to 20 minutes – but caused a new knock-on effect of “immense pressure” on emergency department staff.
Nottingham University Hospitals Trust ( NUH ) executives met on Thursday (January 9) in a board meeting to discuss its recent operational performance. The trust, which runs Nottingham Queen’s Medical Centre and City Hospital, began making changes last month to try to urgently cut ambulance patient handover times at the hospital.
Last winter, from late 2023 to early 2024, waiting times for crews to handover patients to Nottingham hospitals made up around 50 percent of East Midlands Ambulance Services’ ( EMAS ) delays.
To reduce ambulance hospital handover times, the trust has piloted a scheme to keep them at 45 minutes while simultaneously making efforts to reduce the number of patients who are not ‘high risk’ being in the emergency department.
For example, some patients who require urgent treatment, but are not deemed high risk, are instead being directed towards the Urgent Treatment Centre, to ease the numbers of people in the emergency department.
Some of the trust’s call handlers have also been taking calls from people needing health care, which means fewer ambulances are needing to be sent out. As a result of the pilot scheme, and efforts to divert some patients from A&E, more ambulances are now getting back out onto the road – and answering some calls faster across Nottinghamshire.
For example, EMAS is now getting to ‘category 2’ patients – those needing prompt attention for issues like chest pains and stroke symptoms – between 15 to 20 minutes faster.
This has then caused a knock-on effect in the NHS system of “immense pressure” on A&E staff and across the hospitals as they deal with a sudden faster arrival and flow of patients. Mark Simmonds, deputy medical director, said: “This is a question of what the greatest risk for our patients is.
“Being at home waiting for an ambulance, with chest pain, with a stroke, are time-important events – we’ve recognised as a system the worst thing we can do is to constrain the ambulance service. That doesn’t mean the problem’s gone away, it means we have moved that risk elsewhere.”
Mr Simmonds says this has led to ‘corridor care’ – where patients queue on beds in corridors, while the hospital tries to cope with the number of patients needing support.
However, he adds this has been contained to the emergency department corridors this winter – an improvement on previous years. He said: “We haven’t crowded our majors unit or our resuscitation departments.
“The pressure has moved through the hospital, taking extra patients on wards – we haven’t had the stacking of patients in terrible circumstances seen in previous years.”
Services like virtual wards, where patients receive their care at home and the increase in discharge of medically-safe patients has also helped to “relieve the pinch point at the front door”.
Mr Simmonds says the trust is committed to ‘eradicating’ emergency department corridor care by next winter. He added: “On one hand we’re celebrating to an extent but we have to recognise and apologise that this does mean difficulties for our patients and our staff at times.
Trust chief operating officer Lisa Kelly added: “Colleagues absolutely recognise the logic of why we’re doing this, but the relentlessness they’re seeing day in day out on their shifts means this is a challenging environment to work in at the moment.
“We will continue to work with them to see if there’s anything we can do to support them.”