UK survey reveals variations in care provided across the country

Over 600,000 emergency calls to 999 during the first wave of the pandemic were for suspected Covid, with ambulances sent in almost 80% of cases and 43% of patients being conveyed to hospital, a major new survey of UK ambulance services has shown.

Some services were much harder hit than others, with almost half of all calls to one service being Covid-related at its peak.

Care received varied widely by geographic area, with ambulances sent to under 60% of Covid callers in one service, but to 100% in another. The number of patients taken to hospitals varied between 32% and 54% across the country.

The findings will help ambulance experts and policymakers plan for further waves and future pandemics, showing patterns of demand, and helping improve the safety and effectiveness of the NHS response.

The research was carried out by a team from Swansea University Medical School. They surveyed all 13 UK ambulance services, receiving responses from 12, asking them for data for the 22 weeks between 1 February, just after the first confirmed UK case of Covid, and 27 June.

Analyzing the data they received, the team found:

• 604,146 of the calls received were for suspected Covid, which is 13.5% of all calls to 999 over the period
• The number of suspected Covid calls to 999 varied widely during the period, with the highest level across the UK occurring in week 7, though all ambulance services recorded lower levels by the end of the period
• There was much variation across the country and over time, with areas with high rates of Covid infection and hospitalization showing higher rates of 999 calls
• The highest rate of suspected Covid calls observed was 44.5% – recorded by one ambulance service in one week
• Ambulances were dispatched to 79% of the calls, with 43% resulting in the patient being taken to hospital
• The triage procedures used to assess urgency – both in the 999 call center and at the scene – varied significantly between ambulance services and overtime

As well as shedding light on patterns of demand, the findings can provide insights to help improve the triage process, which is crucial in providing the most appropriate care and making the best use of NHS resources.

Triage is a process of assessing how severe and urgent a case is. Calls made to 999 are triaged twice: once in the call center, to decide on appropriate response and timing, and then a second time at the scene if an ambulance is sent.

Getting triage right is crucial. A wrong decision to not send an ambulance, or to leave a patient at home, can result in avoidable serious or critical illness or death. But taking patients to hospital unnecessarily means extra pressure on the NHS, resources being diverted from more seriously ill people, and unnecessary exposure to the risk of infection.

Professor Helen Snooks of Swansea University Medical School, lead researcher, said:

"Our data shows clearly that COVID-19 brought a high additional workload to the UK's ambulance services at a time of high uncertainty and fear. This applies to the call center-; with new protocols for triage and advice – at the scene and at the hospital, with infection control and personal protective equipment requirements, and a high incidence of ambulances queuing outside A&E departments."

The findings reveal a lot of variation between ambulance services in their response. Variation in the care provided means that people receive a different response depending on where they live. This is a red-flag marker of concern for quality and safety, as recently highlighted in a review of ambulance service provision."

Helen Snooks, Study Lead Researcher and Professor, Swansea University Medical School

"The pandemic is not over. So gaining a greater understanding of patterns of demand for the emergency ambulance service, and the safety and effectiveness of the different models of triage and response are crucial in order to inform policy and patient safety," concluded Snooks.

The research was published in the Journal of the American College of Emergency Physicians.