[Case Study] Improving The Emergency Department Handover Through Digital Innovation

How Integrella in partnership with NHS England and London Ambulance Service are changing the paradigm of UEC Patient-Handover

Overview

The 999 Transfer of Care (ToC) programme is a major NHS England initiative, delivered in partnership with London Ambulance Service (LAS), to improve how patients are handed over from ambulances to Emergency Departments.

Integrella was commissioned by NHS England to design and deliver the integration architecture that enables clinical information to flow securely and automatically from ambulance systems into hospital Electronic Patient Records (EPRs). By replacing manual, paper-based handovers with real-time digital information sharing, the programme is helping improve patient flow, reduce delays and support faster clinical decision-making across London’s urgent and emergency care system.

The Challenge

London’s urgent and emergency care system manages more than 1,620 ambulance conveyances every day, equating to over 590,000 patient handovers each year. Historically, handovers relied on verbal communication and paper records, requiring hospital staff to manually re-enter patient information into their EPR systems.

This created several challenges:

• Manual data entry across multiple systems
• Delayed access to clinical information
• Risk of transcription errors
• Longer ambulance turnaround times
• Increased pressure on Emergency Departments
• Difficulty delivering a consistent solution across multiple NHS Trusts and EPR platforms

The Solution

Integrella worked closely with NHS England, London Ambulance Service and NHS Trusts to design and deliver a cloud-based digital Transfer of Care solution.

The new platform securely transfers key patient information directly from the LAS electronic Patient Care Record (ePCR) into hospital EPR systems before the patient arrives. This gives Emergency Department teams earlier visibility of patient information, helping them prepare care pathways, allocate beds and begin clinical decision-making sooner. On arrival, the patient’s complete record is automatically available within the Trust’s EPR, removing duplicate data entry and streamlining the handover process.

Integrella’s role included:

• Designing the cloud-based solution architecture
• Delivering integration across ambulance systems, Trust EPRs and the One London Care Record
• Enabling HL7 and FHIR interoperability
• Conducting discovery and workflow assessments across London Trusts
• Ensuring the solution was clinically safe, scalable and repeatable across Epic and Oracle Health environments

Integrella acted as the integration authority, bringing together ambulance services, NHS Trusts, EPR suppliers and regional data platforms into a single connected ecosystem.

Testimonials

“The 999 Transfer of Care programme is removing friction from one of the most time-critical points in the patient journey. By automating the flow of accurate, real-time information ahead of arrival in the emergency department, we’re reducing manual transcription, supporting earlier triage and release ambulance crews back to patients faster – directly supporting our ambition to improve Category 2 response times. Integrella has been a key delivery partner, co-designing with our clinicians and Trusts to deliver a robust, secure integration built around patient safety and operational reliability.”

Mark Bamlett, Deputy Director – Urgent and Emergency Care (Digital and IUC)

“Hope more hospitals roll this out – would make a big difference across the board.”

Paramedic, LAS Ambulance Clinician 

“The digital data transfer has only enhanced our triage process and hope other hospitals get this soon. It saves 2-3 minutes from the handover conversation and allows me to review incoming patient data ahead of time”

Triage Nurse, PRUH 

Outcomes

The 999 Transfer of Care programme has transformed how patient information is shared across London’s urgent and emergency care system, improving operational efficiency, patient safety and frontline clinical workflows.

Key outcomes include:

• Supporting over 1,620 ambulance conveyances every day
• Digitising more than 590,000 patient handovers annually
• 85% digital adoption across live sites
• 95% real-time transfer success rate
• Saving 2–5 minutes per patient handover
• Reduced duplicate data entry and administrative workload
• Earlier clinical decision-making through pre-arrival patient visibility
• Improved Emergency Department flow and ambulance turnaround times
• A scalable integration model that can be rapidly deployed across additional NHS Trusts nationwide