Half of ambulance arrivals ‘inappropriate’, says acute trust

The assessment at Scarborough Hospital in Yorkshire, obtained by HSJ through a freedom of information request, examined a random sample of 100 patients, of which around 50 arrived by ambulance.

Of those arriving by ambulance, half were deemed not to have required an ambulance conveyance. 

It comes amid rising tensions between hospitals and ambulance trusts, with paramedics being frequently delayed when trying to hand patients over to hospital staff. This has led to frustration from some in the hospital sector at the numbers of patients being conveyed.

The Missed Opportunities Audit, which the trust said was “routine” and looked at a range of areas where the emergency department could streamline operations, said: “Fifty-two per cent of conveyance[s] by ambulances were deemed as inappropriate.

“The reviewer did not have access to the policies of Yorkshire Ambulance Service, which may account for the low number of appropriate conveyances. However, based on clinical judgment for cases presenting by ambulance the arrivals should have presented either to a community service (33 per cent) or via their own transportation methods (38 per cent), as their documented clinical condition and social circumstances allowed for this.”

The author of the June 2022 audit, whose identity has been redacted but is understood to be a senior clinician, called for a further review of conveyance criteria.

According to national statistics published by NHS England, YAS consistently reports higher ED conveyance rates than most other ambulance trusts. 

The report added: “Inappropriate conveyances adversely impact on triage times, and result in fewer ambulances on the road for conveyance of patients in need of emergency, and lifesaving, care. The results highlighted here need to begin a review of conveyance criteria and review of further records of patients who have been conveyed to ED to provide a larger sample.”

Nick Smith, executive director of operations at YAS, said: “Decisions made to convey patients to an emergency department are clinically based and are considered in light of the availability of any other appropriate services. In North Yorkshire last month… of the 14,000 emergency calls received, 6 per cent were resolved over the phone without the need to dispatch an ambulance and a further 33 per cent of patients were seen and treated at the scene without the need to convey to an emergency department.”

The audit also found two-thirds of walk-in patients who were streamed to the ED by triage staff could have been sent either directly to emergency assessment, to the urgent care centre, or to community services.

A spokeswoman for York and Scarborough Teaching Hospitals said the audit was a routine piece of work that had led to several improvements being implemented.