East Midlands Ambulance Service
NHS / Health Body
Action Taken
The ambulance service provided data on transfer times between hospitals and stated they continue to monitor performance and take action to improve operational response. They have instructed all staff to remove the WISER App from work phones unless properly trained. (AI summary)
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Dear Ms Serrano Regulation 28 Prevention of Future Deaths report_ regarding the case of Mr Gordon Gillott deceased Thank you for your letter of 4 February 2020 and the accompanying report into the death of Mr Gordon Gillott Unfortunately, no correspondence was received by East Midlands Ambulance Service reference concerns raised by the General and Vascular Surgeon at the Royal Derby Hospital until we were contacted by the coroner's office: If we had been contacted we would have supplied the hospital and your office with information regarding transfers between Chesterfield and Derby Hospitals and their time frames in which East Midlands Ambulance Service responded to them over the past 12 months; We would have also given you the information regarding the new national procedure for all requests for transport between hospital sites which commenced on the 1 October
2019. We are pleased to be able to provide you with this information now: Respond Develop | Collaborate Way
The PFD we have received raises a concern that an ambulance was not dispatched within the Category 2 response standard of 18 minutes on average and responding to 90% of Category 2 calls in 40 minutes Whilst it is acknowledged that this did not impact on the outcome in this case; there is a concern regarding patient impact of future delays:: When Chesterfield Royal Hospital requested a transfer to the Royal Derby Hospital; East Midlands Ambulance Service was in Capacity Management Plan CMP, level three The Capacity Management Plan (CMP) is designed to manage demand and resources during high periods of demand, where the supply of normal ambulance service resources is insufficient or potentially insufficient to meet the clinical demand of patients. The aim of the CMP actions is to maximise responses to the most seriously unwell patients. There are four levels of CMP as set out in the table below. CMP Escalation Trigger EMAS Authorisation level Normal No Issues 'business as usual' 40 calls of any trigger category being EOC Tactical Commander CMP Regional held DM EOC Tactical Commander 55 calls of any trigger category CMP 2 Regional Trust Strategic held Commander Prolonged period of demand (not Trust Strategic CMP 3 spike) or more than 70 calls being Regional Commanderl Executive on held call Initiated when- major incident is CEO/Exec ` on call & lead CMP 4 declared and all other actions have Regional commissioner failed to mitigate the circumstances The delay for the transfer on this occasion was due to higher than anticipated levels of 999 calls (in particular those in the highest priority category) and the impact of hospital handover delays. EMAS must respond to emergencies with the same call prioritisation code in time order for example; category two calls within 19 minutes with a 90th percentile of 40 minutes, this includes whether are in the community or in a hospital environment At the time of Mr Gillott's call the trust was in CMP 3 holding over 70 CMP qualifying calls. The handover delays at the two hospitals involved in the care of Mr Gillott between the hours of 19.00hrs on 7 August and 07:OOhrs on 8 August are stated below with 460 ambulances attending the hospitals within this time frame. Respond | Develop Collaborate being they
Chesterfield Royal Hospital
19.0Ohrs 07/08/18 to 07 OOhrs on the 08/08/2018 Handover times in minutes The nationally agreed handover time is 15 minutes 15 + 20 + 30 45 30 59 1 -2 hours minutes minutes minutes minutes minutes 132 20 16 16 ambulances ambulances ambulances ambulance ambulance ambulance Derby Royal Hospital
19.0Ohrs 07/08/18 to 07:0Ohrs on the 08/08/2018 Handover times in minutesThe nationally agreed handover time is 15 minutes 15 20 30 + 45 30 59
-2 hours minutes minutes minutes minutes minutes 186 128 40 13 36 5 ambulances ambulances ambulances ambulance ambulance ambulance The above delays resulted in 34 lost hours of operational response availability; impacting on our ability to attend patients in timely manner_ EMAS implemented the new national Health Care Professional Admissions and Inter- Facility Transfers Framework on the 1 October 2019. We have included the National Framework for Interfacility Transfers document for your information: Inter-facility transfers must be from an approved site; transfers requested from other sites will be treated as health care professional admissions. Before the introduction of the new procedure all requests from hospitals were a priority one response based on the category 2 timeframe: The introduction of the new procedure ensures that the correct response standard is obtained and dispatched accordingly: The patient awaiting transfer must be ready to leave for their destination within 15 minutes of the transport arriving: Unfortunately we routinely experience delays on arrival which leads to further delays in transfer of patients. On the of Mr Gillott's transfer the division had already completed four transfers from Chesterfield Royal Hospital, Other Trusts have introduced their own IFT transport platform to avoid prolonged waits when the ambulance service is experiencing high demand: From the introduction of the new procedure EMAS have responded to the following transfers from Chesterfield to Derby as below and their average timeframes are shown below_ Respond | Develop Collaborate day
Month Pickup Hospital Hospital Total Crew waiting Mean Name IFT CAT time for Response patient to be ready to leave October Chesterfield Royal
00.20.44
00.40.27 2019 Royal Hospital Derby Hospital November Chesterfield Royal
00.25:18
00.39.50 2019 Royal Hospital Derby Hospital December Chesterfield Royal
00.26.21
00.29.32 2019 Royal Hospital Derby Hospital_ January Chesterfield Royal
00.29.54
00.34.25 2020 Royal Hospital Derby Hospital We continue to monitor performance and take action to improve our operational response. have enclosed a copy of a table outlining the actions we are taking, including those that are in collaboration with system partners hope that the information provided satisfies the questions you have raised and demonstrates the changes that have been implemented to improve IFT responses. can only apologise to the vascular surgeon that we did not provide the transfer in a timely manner and we are more than happy to keep an open dialogue with the hospital if have any future concerns_ Please do not hesitate to contact me further ifyou require any other assistance in this matter:
2019. We are pleased to be able to provide you with this information now: Respond Develop | Collaborate Way
The PFD we have received raises a concern that an ambulance was not dispatched within the Category 2 response standard of 18 minutes on average and responding to 90% of Category 2 calls in 40 minutes Whilst it is acknowledged that this did not impact on the outcome in this case; there is a concern regarding patient impact of future delays:: When Chesterfield Royal Hospital requested a transfer to the Royal Derby Hospital; East Midlands Ambulance Service was in Capacity Management Plan CMP, level three The Capacity Management Plan (CMP) is designed to manage demand and resources during high periods of demand, where the supply of normal ambulance service resources is insufficient or potentially insufficient to meet the clinical demand of patients. The aim of the CMP actions is to maximise responses to the most seriously unwell patients. There are four levels of CMP as set out in the table below. CMP Escalation Trigger EMAS Authorisation level Normal No Issues 'business as usual' 40 calls of any trigger category being EOC Tactical Commander CMP Regional held DM EOC Tactical Commander 55 calls of any trigger category CMP 2 Regional Trust Strategic held Commander Prolonged period of demand (not Trust Strategic CMP 3 spike) or more than 70 calls being Regional Commanderl Executive on held call Initiated when- major incident is CEO/Exec ` on call & lead CMP 4 declared and all other actions have Regional commissioner failed to mitigate the circumstances The delay for the transfer on this occasion was due to higher than anticipated levels of 999 calls (in particular those in the highest priority category) and the impact of hospital handover delays. EMAS must respond to emergencies with the same call prioritisation code in time order for example; category two calls within 19 minutes with a 90th percentile of 40 minutes, this includes whether are in the community or in a hospital environment At the time of Mr Gillott's call the trust was in CMP 3 holding over 70 CMP qualifying calls. The handover delays at the two hospitals involved in the care of Mr Gillott between the hours of 19.00hrs on 7 August and 07:OOhrs on 8 August are stated below with 460 ambulances attending the hospitals within this time frame. Respond | Develop Collaborate being they
Chesterfield Royal Hospital
19.0Ohrs 07/08/18 to 07 OOhrs on the 08/08/2018 Handover times in minutes The nationally agreed handover time is 15 minutes 15 + 20 + 30 45 30 59 1 -2 hours minutes minutes minutes minutes minutes 132 20 16 16 ambulances ambulances ambulances ambulance ambulance ambulance Derby Royal Hospital
19.0Ohrs 07/08/18 to 07:0Ohrs on the 08/08/2018 Handover times in minutesThe nationally agreed handover time is 15 minutes 15 20 30 + 45 30 59
-2 hours minutes minutes minutes minutes minutes 186 128 40 13 36 5 ambulances ambulances ambulances ambulance ambulance ambulance The above delays resulted in 34 lost hours of operational response availability; impacting on our ability to attend patients in timely manner_ EMAS implemented the new national Health Care Professional Admissions and Inter- Facility Transfers Framework on the 1 October 2019. We have included the National Framework for Interfacility Transfers document for your information: Inter-facility transfers must be from an approved site; transfers requested from other sites will be treated as health care professional admissions. Before the introduction of the new procedure all requests from hospitals were a priority one response based on the category 2 timeframe: The introduction of the new procedure ensures that the correct response standard is obtained and dispatched accordingly: The patient awaiting transfer must be ready to leave for their destination within 15 minutes of the transport arriving: Unfortunately we routinely experience delays on arrival which leads to further delays in transfer of patients. On the of Mr Gillott's transfer the division had already completed four transfers from Chesterfield Royal Hospital, Other Trusts have introduced their own IFT transport platform to avoid prolonged waits when the ambulance service is experiencing high demand: From the introduction of the new procedure EMAS have responded to the following transfers from Chesterfield to Derby as below and their average timeframes are shown below_ Respond | Develop Collaborate day
Month Pickup Hospital Hospital Total Crew waiting Mean Name IFT CAT time for Response patient to be ready to leave October Chesterfield Royal
00.20.44
00.40.27 2019 Royal Hospital Derby Hospital November Chesterfield Royal
00.25:18
00.39.50 2019 Royal Hospital Derby Hospital December Chesterfield Royal
00.26.21
00.29.32 2019 Royal Hospital Derby Hospital_ January Chesterfield Royal
00.29.54
00.34.25 2020 Royal Hospital Derby Hospital We continue to monitor performance and take action to improve our operational response. have enclosed a copy of a table outlining the actions we are taking, including those that are in collaboration with system partners hope that the information provided satisfies the questions you have raised and demonstrates the changes that have been implemented to improve IFT responses. can only apologise to the vascular surgeon that we did not provide the transfer in a timely manner and we are more than happy to keep an open dialogue with the hospital if have any future concerns_ Please do not hesitate to contact me further ifyou require any other assistance in this matter: