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Multicenter Study
. 2015 Jun;27(3):216-24.
doi: 10.1111/1742-6723.12399. Epub 2015 May 5.

Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed

Julia Crilly  1   2 , Gerben Keijzers  1   3 , Vivienne Tippett  4 , John O'Dwyer  5 , James Lind  1 , Nerolie Bost  1 , Marilla O'Dwyer  5 , Sue Shiels  6 , Marianne Wallis  2   7
Affiliations
Multicenter Study

Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed

Julia Crilly et al. Emerg Med Australas. 2015 Jun.

Abstract

Objective: To describe and compare characteristics and outcomes of patients who arrive by ambulance to the ED. We aimed to (i) compare patients with a delayed ambulance offload time (AOT) >30 min with those who were not delayed; and (ii) identify predictors of an ED length of stay (LOS) of >4 h for ambulance-arriving patients.

Methods: A retrospective, multi-site cohort study was undertaken in Australia using 12 months of linked health data (September 2007-2008). Outcomes of AOT delayed and non-delayed presentations were compared. Logistic regression analysis was undertaken to identify predictors of an ED LOS of >4 h.

Results: Of the 40 783 linked, analysable ambulance presentations, AOT delay of >30 min was experienced by 15%, and 63% had an ED LOS of >4 h. Patients with an AOT <30 min had better outcomes for: time to triage; ambulance time at hospital; time to see healthcare professional; proportion seen within recommended triage time frame; and ED LOS for both admitted and non-admitted patients. In-hospital mortality did not differ. Strong predictors of an ED LOS >4 h included: hospital admission, older age, triage category, and offload delay >30 min.

Conclusion: Patients arriving to the ED via ambulance and offloaded within 30 min experience better outcomes than those delayed. Given that offload delay is a modifiable predictor of an ED LOS of >4 h, targeted improvements in the ED arrival process for ambulance patients might be useful.

Keywords: ambulance; data linkage; emergency department; offload delay; outcome.

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Figures

Figure 1
Figure 1
Sample inclusion flow diagram (data from three hospitals; 12 months).
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References

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