At the heart of the ambulance problem is patient handover time

The service has drawn up a new strategy to tackle delays crisis

In April, ambulance crews waited an average 35 minutes to hand over patients  at  Limerick Regional. Photograph: Dara Mac Dónaill / THE IRISH TIMES

In April, ambulance crews waited an average 35 minutes to hand over patients at Limerick Regional. Photograph: Dara Mac Dónaill / THE IRISH TIMES

Mon, Jun 9, 2014, 01:00

When an ambulance is delayed at an emergency department (ED) not only is the patients enduring additional distress, but the ambulance is denied to someone in the community who may desperately need it.

The HSE knows this. Its National Ambulance Service (NAS) has come in for severe criticism in recent months after a series of deaths involving people who, despite having been triaged by dispatchers as needing an emergency response within 20 minutes, were left waiting for up to 45 minutes for the ambulance to arrive.

At the end of last year, in its National Performance Assurance Report, the HSE identified ambulance delays at emergency departments as a key obstacle to tackling the unacceptable situation where ambulances were repeatedly failing to meet the HSE’s target response times.

Hospital turnaround times would “be an area of particular focus by the NAS in 2014”, said the HSE.

Ambulances delays at EDs are not of the NAS’s making. Paramedics cannot hand over a patient to an ED that is full to bursting point.

Emergency consultants across the State have spoken to The Irish Times of the unbearable pressure they are working under.

Just last week the Health Information and Quality Authority described the biggest ED in the mid-west, at Limerick Regional Hospital, as being so overcrowded as to be “unfit for purpose”.

Four hours

To take this ED, figures released to Independent TD Denis Naughten last week on ambulance turnaround times show that the 1,128 ambulances that pulled up at Limerick Regional Hospital in April spent an average of 35 minutes waiting to hand over patients. Some 123 of them, or 11 per cent, waited over an hour – including six that waited three to four hours.

The figures obtained by Mr Naughten show that in April 6,206 ambulances, out of a total of 16,333 ambulance attendances at EDs in the month, were delayed for over 30 minutes outside EDs across the State.

Some 1,407 ambulance were delayed for over an hour, of which 1,225 were delayed for between one and two hours. Some 139 were waiting two to three hours; 35 for three to four hours; six for four to five hours; one waited between five and six hours outside Cork University Hospital, while one was left waiting between seven and 14 hours outside the ED at Crumlin Children’s Hospital in Dublin.

In total emergency ambulances spent a staggering 8,153 hours and 52 minutes parked outside EDs waiting with their patients. Not only is this frustrating and distressing for the paramedics and patients but it is also dangerous. While ill and distressed patients are in ambulances or on ambulance trolleys they are not in an ED cubicle being cared for.

‘Particularly bad’

Dr Fergal Hickey, spokesman for the Irish Association of Emergency Medicine, says overcrowded EDs and delayed ambulances are dangerous problems all over the country, but are “particularly bad” in Cork.

At Cork University Hospital ambulances waited on average 47 minutes in April, and 23 per cent of ambulances (213 in all) were waiting over an hour, including 30 that waited up to three hours and another four that waited between four and six hours.