title: Analysis and impact of delays in ambulance to emergency department handovers.
abstract: OBJECTIVE
  Delays in the clinical handover of patient care from emergency medical services (EMS) to the ED because of ED crowding are a substantial problem for many EMS systems. This study was conducted to quantify handover delays experienced by the Ambulance Service of New South Wales (ASNSW), and to investigate patient and system factors associated with handover delay.
  
  
  METHODS
  A retrospective study of EMS dispatch and ambulance patient care records was conducted for all patients transported by ASNSW in January/April/July/October 2009. Patient characteristics and time intervals were summarised using descriptive statistics, with handover delay categorised as <30 min, 30-60 min and ≥60 min. Times are reported as HH:MM:SS. Partial proportional odds models were used to investigate factors associated with delays.
  
  
  RESULTS
  Of 141 381 transports, 12.5% of patients experienced a handover delay of 30-60 min, and 5% a delay of ≥60 min. The median handover interval was 00:15:46 (IQR 00:08:58-00:24:52, maximum 08:43:13). Patients transported to large hospitals were more likely to experience a delay of ≥30 min (odds ratio [OR] 14.57, 95% CI 11.41-18.60) or ≥60 min (OR 15.75, 95% CI 12.27-20.23) than those transported to small hospitals. Patients in major cities were more likely to experience delays than those in other areas, and patients ≥65 years were more likely to experience delays than those <16 years. Delays were most likely in winter. Cardiac and major trauma patients had the lowest likelihood of experiencing delays.
  
  
  CONCLUSIONS
  Handover delays are relatively common at the EMS/ED interface in New South Wales, and are most pronounced at large hospitals, in urban areas and during winter.
authors.affiliation: Section of EMS, Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. david.cone@yale.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Cone
authors.forename: Paul M
authors.initials: PM
authors.lastname: Middleton
authors.forename: Sadaf
authors.initials: S
authors.lastname: Marashi Pour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D057210:Delayed Diagnosis / Q000517:prevention & control* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D016017:Odds Ratio; D010360:Patient Transfer / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult