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How are handover delays from ambulances to emergency departments being addressed in the United Kingdom? A nationwide survey of ambulance services and emergency departments

Barbara Gomes Orcid Logo, Isobel Joy McFadzean, Timothy Driscoll Orcid Logo, Mark Kingston Orcid Logo, Mari Jones Orcid Logo, Natalie Joseph-Williams, Steve Goodacre, Sioned Gwyn Orcid Logo, Ashra Khanom, Hilary Pillin, Helen Snooks Orcid Logo, Andrew Carson-Stevens, Deborah Fitzsimmons Orcid Logo

BMC Emergency Medicine, Volume: 26, Issue: 1, Start page: 134

Swansea University Authors: Barbara Gomes Orcid Logo, Timothy Driscoll Orcid Logo, Mark Kingston Orcid Logo, Mari Jones Orcid Logo, Sioned Gwyn Orcid Logo, Ashra Khanom, Helen Snooks Orcid Logo, Deborah Fitzsimmons Orcid Logo

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DOI (Published version): 10.1186/s12873-026-01532-9

Abstract

Background: Excessive waiting times and ambulance handover delays are of high concern to healthcare professionals and the public internationally. Ambulance services and emergency departments (EDs) have attempted to mitigate delays but the initiatives implemented have not been systematically describe...

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Published in: BMC Emergency Medicine
ISSN: 1471-227X
Published: Springer Nature 2026
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URI: https://cronfa.swan.ac.uk/Record/cronfa71791
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A nationwide survey of ambulance services and emergency departments</title><swanseaauthors><author><sid>1a8104f9603508df48d75cf75395c93f</sid><ORCID>0000-0001-9664-5425</ORCID><firstname>Barbara</firstname><surname>Gomes</surname><name>Barbara Gomes</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>2be5c329c44d14550ceac4934fcb409e</sid><ORCID>0000-0001-9879-2509</ORCID><firstname>Timothy</firstname><surname>Driscoll</surname><name>Timothy Driscoll</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3442763d6ff0467963e0792d2b5404fa</sid><ORCID>0000-0003-2242-4210</ORCID><firstname>Mark</firstname><surname>Kingston</surname><name>Mark Kingston</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>8e326860810f5f960b088db10ef58906</sid><ORCID>0000-0001-9661-4899</ORCID><firstname>Mari</firstname><surname>Jones</surname><name>Mari Jones</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>7296a3a08d04137e6bed7b10ed2edd64</sid><ORCID>0009-0005-5301-8356</ORCID><firstname>Sioned</firstname><surname>Gwyn</surname><name>Sioned Gwyn</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>1f0f14742e3a36e8fd6d29f59374a009</sid><ORCID/><firstname>Ashra</firstname><surname>Khanom</surname><name>Ashra Khanom</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>ab23c5e0111b88427a155a1f495861d9</sid><ORCID>0000-0003-0173-8843</ORCID><firstname>Helen</firstname><surname>Snooks</surname><name>Helen Snooks</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>e900d99a0977beccf607233b10c66b43</sid><ORCID>0000-0002-7286-8410</ORCID><firstname>Deborah</firstname><surname>Fitzsimmons</surname><name>Deborah Fitzsimmons</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2026-04-24</date><deptcode>MEDS</deptcode><abstract>Background: Excessive waiting times and ambulance handover delays are of high concern to healthcare professionals and the public internationally. Ambulance services and emergency departments (EDs) have attempted to mitigate delays but the initiatives implemented have not been systematically described. To inform site selection for a national evaluation of such initiatives (the STALLED study), we set out to identify and describe initiatives that have been implemented at the ED entrance to address delayed ambulance handover in the United Kingdom (UK). Methods: Survey of current practice in all UK ambulance services (a total of 13) using a semi-structured questionnaire, distributed by email, focusing on initiatives based at the door of emergency departments, for completion and return by email or telephone interview. We also sent the questionnaire to a purposive sample of 24 EDs, identified from ambulance service responses. We summarised and coded initiatives reported and mapped them to the Systems Engineering Initiative for Patient Safety model, to support an understanding of where and how those initiatives influenced the healthcare system. Results: Twelve of 13 ambulance services and 16 of 24 EDs responded to the questionnaire describing 34 and 36 initiatives respectively. All respondents reported having several (between two and 12 per service) initiatives in place to reduce handover delays, most commonly involving ambulance staff caring for groups of patients in ED corridors (8/12), coordinated patient handovers within a defined time period (7/12), and ED reconfiguration to facilitate rapid offload (10/16). Most initiatives focussed on changes which influenced the organisation of care, the introduction or revision of key tasks and roles for staff, as well as changes to the ED environment. Conclusions: Ambulance services and EDs have implemented a variety of initiatives to reduce handover delays. Most of the initiatives involve multiple parts of the system, including tasks, staff, the organisation and the internal environment. These complex initiatives require careful study to understand how they work and how they can inform best practice.</abstract><type>Journal Article</type><journal>BMC Emergency Medicine</journal><volume>26</volume><journalNumber>1</journalNumber><paginationStart>134</paginationStart><paginationEnd/><publisher>Springer Nature</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1471-227X</issnElectronic><keywords>Ambulance queuing; Ambulance service; Emergency department; Handover delays; Ambulance ramping; Ambulance offload delays; Crowding; Patient flow; Survey; Systems thinking</keywords><publishedDay>31</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2026</publishedYear><publishedDate>2026-12-31</publishedDate><doi>10.1186/s12873-026-01532-9</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>External research funder(s) paid the OA fee (includes OA grants disbursed by the Library)</apcterm><funders>NIHR [Health and Social Care Delivery Research (HSDR) Programme (award ID NIHR159967)].</funders><projectreference/><lastEdited>2026-05-12T10:14:21.1724429</lastEdited><Created>2026-04-24T12:17:41.8073849</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Barbara</firstname><surname>Gomes</surname><orcid>0000-0001-9664-5425</orcid><order>1</order></author><author><firstname>Isobel Joy</firstname><surname>McFadzean</surname><order>2</order></author><author><firstname>Timothy</firstname><surname>Driscoll</surname><orcid>0000-0001-9879-2509</orcid><order>3</order></author><author><firstname>Mark</firstname><surname>Kingston</surname><orcid>0000-0003-2242-4210</orcid><order>4</order></author><author><firstname>Mari</firstname><surname>Jones</surname><orcid>0000-0001-9661-4899</orcid><order>5</order></author><author><firstname>Natalie</firstname><surname>Joseph-Williams</surname><order>6</order></author><author><firstname>Steve</firstname><surname>Goodacre</surname><order>7</order></author><author><firstname>Sioned</firstname><surname>Gwyn</surname><orcid>0009-0005-5301-8356</orcid><order>8</order></author><author><firstname>Ashra</firstname><surname>Khanom</surname><orcid/><order>9</order></author><author><firstname>Hilary</firstname><surname>Pillin</surname><order>10</order></author><author><firstname>Helen</firstname><surname>Snooks</surname><orcid>0000-0003-0173-8843</orcid><order>11</order></author><author><firstname>Andrew</firstname><surname>Carson-Stevens</surname><order>12</order></author><author><firstname>Deborah</firstname><surname>Fitzsimmons</surname><orcid>0000-0002-7286-8410</orcid><order>13</order></author></authors><documents><document><filename>71791__36708__476c693cb776456a8a9903cf1fee5662.pdf</filename><originalFilename>71791.VOR.pdf</originalFilename><uploaded>2026-05-12T10:10:14.1586617</uploaded><type>Output</type><contentLength>983640</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s) 2026. 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spelling 2026-05-12T10:14:21.1724429 v2 71791 2026-04-24 How are handover delays from ambulances to emergency departments being addressed in the United Kingdom? A nationwide survey of ambulance services and emergency departments 1a8104f9603508df48d75cf75395c93f 0000-0001-9664-5425 Barbara Gomes Barbara Gomes true false 2be5c329c44d14550ceac4934fcb409e 0000-0001-9879-2509 Timothy Driscoll Timothy Driscoll true false 3442763d6ff0467963e0792d2b5404fa 0000-0003-2242-4210 Mark Kingston Mark Kingston true false 8e326860810f5f960b088db10ef58906 0000-0001-9661-4899 Mari Jones Mari Jones true false 7296a3a08d04137e6bed7b10ed2edd64 0009-0005-5301-8356 Sioned Gwyn Sioned Gwyn true false 1f0f14742e3a36e8fd6d29f59374a009 Ashra Khanom Ashra Khanom true false ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false e900d99a0977beccf607233b10c66b43 0000-0002-7286-8410 Deborah Fitzsimmons Deborah Fitzsimmons true false 2026-04-24 MEDS Background: Excessive waiting times and ambulance handover delays are of high concern to healthcare professionals and the public internationally. Ambulance services and emergency departments (EDs) have attempted to mitigate delays but the initiatives implemented have not been systematically described. To inform site selection for a national evaluation of such initiatives (the STALLED study), we set out to identify and describe initiatives that have been implemented at the ED entrance to address delayed ambulance handover in the United Kingdom (UK). Methods: Survey of current practice in all UK ambulance services (a total of 13) using a semi-structured questionnaire, distributed by email, focusing on initiatives based at the door of emergency departments, for completion and return by email or telephone interview. We also sent the questionnaire to a purposive sample of 24 EDs, identified from ambulance service responses. We summarised and coded initiatives reported and mapped them to the Systems Engineering Initiative for Patient Safety model, to support an understanding of where and how those initiatives influenced the healthcare system. Results: Twelve of 13 ambulance services and 16 of 24 EDs responded to the questionnaire describing 34 and 36 initiatives respectively. All respondents reported having several (between two and 12 per service) initiatives in place to reduce handover delays, most commonly involving ambulance staff caring for groups of patients in ED corridors (8/12), coordinated patient handovers within a defined time period (7/12), and ED reconfiguration to facilitate rapid offload (10/16). Most initiatives focussed on changes which influenced the organisation of care, the introduction or revision of key tasks and roles for staff, as well as changes to the ED environment. Conclusions: Ambulance services and EDs have implemented a variety of initiatives to reduce handover delays. Most of the initiatives involve multiple parts of the system, including tasks, staff, the organisation and the internal environment. These complex initiatives require careful study to understand how they work and how they can inform best practice. Journal Article BMC Emergency Medicine 26 1 134 Springer Nature 1471-227X Ambulance queuing; Ambulance service; Emergency department; Handover delays; Ambulance ramping; Ambulance offload delays; Crowding; Patient flow; Survey; Systems thinking 31 12 2026 2026-12-31 10.1186/s12873-026-01532-9 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University External research funder(s) paid the OA fee (includes OA grants disbursed by the Library) NIHR [Health and Social Care Delivery Research (HSDR) Programme (award ID NIHR159967)]. 2026-05-12T10:14:21.1724429 2026-04-24T12:17:41.8073849 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Barbara Gomes 0000-0001-9664-5425 1 Isobel Joy McFadzean 2 Timothy Driscoll 0000-0001-9879-2509 3 Mark Kingston 0000-0003-2242-4210 4 Mari Jones 0000-0001-9661-4899 5 Natalie Joseph-Williams 6 Steve Goodacre 7 Sioned Gwyn 0009-0005-5301-8356 8 Ashra Khanom 9 Hilary Pillin 10 Helen Snooks 0000-0003-0173-8843 11 Andrew Carson-Stevens 12 Deborah Fitzsimmons 0000-0002-7286-8410 13 71791__36708__476c693cb776456a8a9903cf1fee5662.pdf 71791.VOR.pdf 2026-05-12T10:10:14.1586617 Output 983640 application/pdf Version of Record true © The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License. true eng http://creativecommons.org/licenses/by/4.0/
title How are handover delays from ambulances to emergency departments being addressed in the United Kingdom? A nationwide survey of ambulance services and emergency departments
spellingShingle How are handover delays from ambulances to emergency departments being addressed in the United Kingdom? A nationwide survey of ambulance services and emergency departments
Barbara Gomes
Timothy Driscoll
Mark Kingston
Mari Jones
Sioned Gwyn
Ashra Khanom
Helen Snooks
Deborah Fitzsimmons
title_short How are handover delays from ambulances to emergency departments being addressed in the United Kingdom? A nationwide survey of ambulance services and emergency departments
title_full How are handover delays from ambulances to emergency departments being addressed in the United Kingdom? A nationwide survey of ambulance services and emergency departments
title_fullStr How are handover delays from ambulances to emergency departments being addressed in the United Kingdom? A nationwide survey of ambulance services and emergency departments
title_full_unstemmed How are handover delays from ambulances to emergency departments being addressed in the United Kingdom? A nationwide survey of ambulance services and emergency departments
title_sort How are handover delays from ambulances to emergency departments being addressed in the United Kingdom? A nationwide survey of ambulance services and emergency departments
author_id_str_mv 1a8104f9603508df48d75cf75395c93f
2be5c329c44d14550ceac4934fcb409e
3442763d6ff0467963e0792d2b5404fa
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7296a3a08d04137e6bed7b10ed2edd64
1f0f14742e3a36e8fd6d29f59374a009
ab23c5e0111b88427a155a1f495861d9
e900d99a0977beccf607233b10c66b43
author_id_fullname_str_mv 1a8104f9603508df48d75cf75395c93f_***_Barbara Gomes
2be5c329c44d14550ceac4934fcb409e_***_Timothy Driscoll
3442763d6ff0467963e0792d2b5404fa_***_Mark Kingston
8e326860810f5f960b088db10ef58906_***_Mari Jones
7296a3a08d04137e6bed7b10ed2edd64_***_Sioned Gwyn
1f0f14742e3a36e8fd6d29f59374a009_***_Ashra Khanom
ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks
e900d99a0977beccf607233b10c66b43_***_Deborah Fitzsimmons
author Barbara Gomes
Timothy Driscoll
Mark Kingston
Mari Jones
Sioned Gwyn
Ashra Khanom
Helen Snooks
Deborah Fitzsimmons
author2 Barbara Gomes
Isobel Joy McFadzean
Timothy Driscoll
Mark Kingston
Mari Jones
Natalie Joseph-Williams
Steve Goodacre
Sioned Gwyn
Ashra Khanom
Hilary Pillin
Helen Snooks
Andrew Carson-Stevens
Deborah Fitzsimmons
format Journal article
container_title BMC Emergency Medicine
container_volume 26
container_issue 1
container_start_page 134
publishDate 2026
institution Swansea University
issn 1471-227X
doi_str_mv 10.1186/s12873-026-01532-9
publisher Springer Nature
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background: Excessive waiting times and ambulance handover delays are of high concern to healthcare professionals and the public internationally. Ambulance services and emergency departments (EDs) have attempted to mitigate delays but the initiatives implemented have not been systematically described. To inform site selection for a national evaluation of such initiatives (the STALLED study), we set out to identify and describe initiatives that have been implemented at the ED entrance to address delayed ambulance handover in the United Kingdom (UK). Methods: Survey of current practice in all UK ambulance services (a total of 13) using a semi-structured questionnaire, distributed by email, focusing on initiatives based at the door of emergency departments, for completion and return by email or telephone interview. We also sent the questionnaire to a purposive sample of 24 EDs, identified from ambulance service responses. We summarised and coded initiatives reported and mapped them to the Systems Engineering Initiative for Patient Safety model, to support an understanding of where and how those initiatives influenced the healthcare system. Results: Twelve of 13 ambulance services and 16 of 24 EDs responded to the questionnaire describing 34 and 36 initiatives respectively. All respondents reported having several (between two and 12 per service) initiatives in place to reduce handover delays, most commonly involving ambulance staff caring for groups of patients in ED corridors (8/12), coordinated patient handovers within a defined time period (7/12), and ED reconfiguration to facilitate rapid offload (10/16). Most initiatives focussed on changes which influenced the organisation of care, the introduction or revision of key tasks and roles for staff, as well as changes to the ED environment. Conclusions: Ambulance services and EDs have implemented a variety of initiatives to reduce handover delays. Most of the initiatives involve multiple parts of the system, including tasks, staff, the organisation and the internal environment. These complex initiatives require careful study to understand how they work and how they can inform best practice.
published_date 2026-12-31T06:30:11Z
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score 11.104773

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