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

Julia Crilly; Gerben Keijzers; Vivienne Tippett; John O'Dwyer; James Lind; Nerolie Bost; Marilla O'Dwyer; Sue Shiels; Marianne Wallis

doi:10.1111/1742-6723.12399

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

Julia Crilly^*, Gerben Keijzers, Vivienne Tippett, John O'Dwyer, James Lind, Nerolie Bost, Marilla O'Dwyer, Sue Shiels, Marianne Wallis

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

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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 40783 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.

Original language	English
Pages (from-to)	216-224
Number of pages	9
Journal	EMA - Emergency Medicine Australasia
Volume	27
Issue number	3
DOIs	https://doi.org/10.1111/1742-6723.12399
Publication status	Published - 1 Jun 2015
Externally published	Yes

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Improved outcomes for emergency department patients whose ambulance off‐stretcher time is not delayedFinal published version, 156 KBLicence: CC BY-NC

Cite this

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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 40783 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.",

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AU - Lind, James

AU - Bost, Nerolie

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

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