Improving ambulance and A&E department connectivity

East of England Ambulance Service NHS Trust (EEAST) provides emergency medical services and transport across Bedfordshire, Hertfordshire, Essex, Norfolk, Suffolk, and Cambridgeshire.

In collaboration with NHS England since December 2023, EEAST has trialled a connectivity solution to improve ambulance handovers at 4 hospitals where mobile coverage is insufficient.

EEAST paramedics use handheld devices with 4G connectivity to update electronic patient records (EPR) and share vital information with hospitals via the Summary Care Record (SCR) system.

The SCR provides hospital clinicians with a single, up-to-date source of patient information for effective care. However, poor mobile signal, especially in ambulance bays, often delays this digital handover, disrupting patient care and increasing the risk of errors such as medication duplication or omission.

Connectivity challenges arise from hospital layouts, including metal structures, lead-lined rooms, and outdated designs that hinder signal quality.

These issues frustrate clinicians and impede efficient workflows, as delays in transferring patient data reduce their ability to make timely, informed decisions.

To address this, EEAST aims to provide seamless connectivity at all acute sites, ensuring ambulances can reliably update EPR records without delay.

The solution must meet key criteria:

• guarantee connectivity in hospital bays
• integrate smoothly with ambulance crew devices
• be compatible across all EEAST sites
• avoid negative impacts on hospital operations

By implementing innovative technology, EEAST seeks to eliminate connectivity barriers, improve handover efficiency, and enhance patient outcomes.

The ultimate goal is to create a consistent, reliable connection in ambulance bays to ensure no delays in EPR updates during the critical handover process.

The trust's solution involves installing a Cradlepoint E300 router, wireless access points, and antennas at the hospital site to provide internet access in affected areas. Excelerate Technology, the trust's technology partner, will provide a SIM card. The network provider for each hospital will be selected after a site survey to determine which one offers the greatest throughput at that specific site. Antennas will be strategically placed in and around ambulance bays to receive multiple mobile signals and combine them  into a single Wi-Fi output, which ambulances will connect to automatically upon entering their signal range. EEAST have been testing that this provides the connectivity for ambulance crews to perform a digital handover.

As part of the trial, this solution will be compared to alternative methods employed by other hospitals throughout the region. This will allow EEAST and NHS England determine the best solution for others to follow should they encounter a similar issue.

Key benefits include:

• reduced clinical handover risks, ensuring patient data is shared seamlessly to improve outcomes
• improved handover times, supporting efficiency and trust targets
• enhanced clinician satisfaction, allowing staff to focus on care rather than connectivity issues
• faster ambulance circulation, reducing NHS financial pressures and patient wait times

EEAST is collaborating with busy hospital sites to find the best solutions for each location. Options include extending guest Wi-Fi outdoors, using cellular routers, or hybrid solutions to develop a scalable approach that prioritises patient safety and operational efficiency across acute trusts

After working in collaboration with multiple hospital sites, the trust installed Cradlepoint routers and access points (APs) into the ambulance bays of 4 hospitals: Harlow, Peterborough, Luton and Colchester.

The installation and deployment process for each site was similar, including on site surveys, pre installation planning and technical discussions, and then the installation process itself, where the APs and routers were placed in the ambulance bay.

Each hospital site has its own successes, challenges and lessons learned.

Successes:

• The interaction between EEAST, Excelerate (their chosen supplier), and the hospital’s estates and IT teams proved very effective and helped the deployment go smoothly on the day.
• Co-ordination with the on-site hospital ambulance liaison officer (HALO) ensured that ambulance bays were well managed, and patient care was not affected during the installation.
• Running the survey and installation process under agile principles allowed the requirements to be met with flexibility.

Lessons learned:

• It is vital to identify the correct contacts when deploying at another health organisation’s site, and time taken to identify those contacts will be very useful later on.
• Ensure that suppliers always carry spares of parts involved in the deployment – a bracket was broken during the installation which did not delay the deployment but necessitated a return visit to re-fit.
• This was the trust’s first installation of the trial, and as such there were several unexpected delays. This included technical discussions with the trust and final testing by Excelerate.

The initial installation plan was created while Peterborough had a temporary covering structure in the ambulance bay. The installation plan included running power to a second AP which, rather than being connected to the router via a data cable would distribute the network over a digital mesh system. When the structure was removed, this plan was amended to connect to the second point via a data cable, thereby providing a more reliable connection.

Peterborough Hospital faced additional delays in installing power sockets to support the deployment, meaning that the installation date was changed twice before Excelerate was finally able to deploy.

Peterborough hospital building is a private finance initiative (PFI) building and as such is maintained by the PFI third party. Here, the trust relied heavily on establishing communication with the hospital’s PFI company contractors, which proved difficult until the day of the installation.

Successes:

• the hospital’s IT project manager, estates team and PFI contractor were very helpful during the installation process, once communication could be established.
• there is a future possibility to invite East Midlands Ambulance Service to take advantage of the increased connectivity provided by Excelerate.No additional security requirements will be needed as WMAS will be given completely different access details.
• The trust is considering providing a separate SSID and password, with roll out being via a script which enables frontline crews to switch to the Excelerate connectivity solution seamlessly without logging in.
• This method of connection sharing allowing inter site collaboration and travel has great potential to be explored amongst ambulance trusts and the NHS as a whole. 

Lessons learned:

• Making inroads to get into contact with a site’s PFI company as soon as possible can be helpful for working with them on a deployment. Additionally, allow more time for hospitals with PFI buildings and ensure that key hospital contacts are made who can deal with any issues relating to the PFI.

Luton undertook their own Wi-Fi survey following the trust’s initial meetings.. Based on their research, they decided to install their own ambulance bay connectivity solution in 18 months. EEAST believed the Excelerate box solution would provide immediate interim connectivity, so they continued the deployment.

The hospital requested that the deployment only use one access point instead of the usual two to maintain the look and feel of the ambulance bay. This demonstrates that when working with organisations, many priorities, including aesthetics, must be considered.

Successes:

• The hospital’s security teams were on site to assist with equipment offload throughout the deployment.
• All security protocols were followed and EEAST project manager and hospital clinical lead were on site to assist the HALO should vehicles need moving to accommodate incoming ambulances.

Lessons learned:

• It is important to be flexible and accommodating to the other activities an organisation might be undertaking when deploying at their sites.
• Ensure all members of the IT and estates teams are involved in discussions and make sure that senior team members are kept updated do not rely on other members on their team to update senior members.
• It can be difficult to navigate a hospital teams lack of communication and internal politics.
• Post deployment, users were being sent to an authentication step that was not required and that prevented connection. Changes have been made on the access point through remote setup by Excelerate and this no longer occurs, and users have started to connect again with increased data usage.

At Colchester hospital, Excelerate created a mesh connection between both routers.

As a mesh network, the 2 access points work together to provide Wi-Fi to wireless devices. If one node is busy, the traffic is handed off to another node, even if it is further away. This will allow users to seamlessly connect between both devices installed. 

The trust is reviewing deploying this mesh solution to other sites, particularly at Peterborough Hospital where the trust is planning a return visit to consider a minor move of one of the access points to improve the range of the connection beyond the main ambulance bay.

Successes:

• As this was the final deployment of the trial, lessons learned at the previous hospital locations ensured that EEAST was liaising with the right hospital staff including estates and IT teams which ensured smooth implementation, with no issues encountered.

Overall, EEAST worked effectively with the hospital sites they were deploying to, navigating complex scenarios and managing complex priorities and timescales to install the solution at the 4 sites for testing.

Considering that any solution for ambulance bay connectivity would need to be robust enough to accommodate any situation and site, the challenges overcome here is a good indicator that it is possible to deploy this solution across any hospital site.

The trial significantly improved ambulance connectivity in handover bays, with more than 14,694 users logging 334GB of data. Crews now connect automatically without logging in, eliminating barriers to seamless data transfer. The solution is low maintenance, with minimal impact on hospital networks, as data is backhauled over cellular connections.

Benefits include:

• Improved patient care: Enhanced connectivity ensures accurate, real-time updates to Summary Care Records, reducing clinical risks and improving outcomes.
• Faster handovers: Reliable connections shorten delays, enabling ambulances to return to service quickly.
• Increased staff satisfaction: Reduced frustrations with connectivity allow clinicians to focus on care, boosting morale and trust in the system.
• Operational efficiency: Faster patient handovers alleviate pressure on hospitals and reduce NHS costs.

Feedback has been overwhelmingly positive, with clinicians reporting fewer disruptions and greater optimism about connectivity improvements. Early data from Appendix 1 shows encouraging results in hospital handover times, though further analysis is needed to account for external factors such as seasonal pressures or large-scale emergencies.

The solution’s scalability also benefits other ambulance trusts, with future deployments planned at additional sites. While some technical adjustments, like periodic router resets, are necessary, the trial demonstrates the potential for system-wide adoption to improve patient care and operational efficiency.

Following deployment, the 4 hospital sites require minimal operational support, with intervention needed only for system damage or outages. One identified issue is the need to reset routers periodically to re-establish connectivity. EEAST recommends an automatic reset at 3am daily, minimising downtime to 2–3 minutes during quiet periods.

To further enhance reliability, EEAST is exploring the feasibility of adding dual-SIM configurations, ensuring uninterrupted connectivity during network outages. This improvement is under review for cost and viability.

The trial’s success has prompted plans for additional deployments across EEAST sites, with other ambulance trusts expressing interest in adopting similar solutions. EEAST remains committed to refining the system to deliver scalable, robust connectivity for seamless ambulance handovers.

The solution provided has met the stated objectives of the trial, vastly improving connectivity to crews during a vital part of a patient’s journey. EEAST’s trial has highlighted both the unique challenges that trusts face when first attempting large scale deployments, as well as highlighting the opportunity and benefits that can come from better connectivity.

EEAST will continue to engage with other hospital sites to maximise results.

This trial highlights how successful technical innovation for the NHS encompasses the provision of basic functionality and connectivity where required by the clinical workflows.