title: Evaluation of ambulance offload delay at a university hospital emergency department.
abstract: BACKGROUND
  Ambulance offload delay (AOD) has been recognized by the National Association of EMS Physicians (NAEMSP) as an important quality marker. AOD is the time between arrival of a patient by EMS and the time that the EMS crew has given report and moved the patient off of the EMS stretcher, allowing the EMS crew to begin the process of returning to service. The AOD represents a potential delay in patient care and a delay in the availability of an EMS crew and their ambulance for response to emergencies. This pilot study was designed to assess the AOD at a university hospital utilizing direct observation by trained research assistants.
  
  
  RESULTS
  A convenience sample of 483 patients was observed during a 12-month period. Data were analyzed to determine the AOD overall and for four groups of National Emergency Department Overcrowding Scale (NEDOCS) score ranges. The AOD ranged from 0 min to 157 min with a median of 11 min. When data were grouped by NEDOCS score, there was a statistically significant difference in median AOD between the groups (p < 0.001), indicating the relationship between ED crowding and AOD.
  
  
  CONCLUSIONS
  The median AOD was considered significant and raised concerns related to patient care and EMS system resource availability. The NEDOCS score had a positive correlation with AOD and should be further investigated as a potential marker for determining diversion status or for destination decision-making by EMS personnel.
authors.affiliation: EMS Medicine Fellowship, Department of Emergency Medicine, SUNY Upstate Medical University, 550 East Genesee / EMSTAT Center, Syracuse, NY, 13202, USA. cooneyd@upstate.edu.
authors.forename: Derek R
authors.initials: DR
authors.lastname: Cooney
authors.forename: Susan
authors.initials: S
authors.lastname: Wojcik
authors.forename: Naveen
authors.initials: N
authors.lastname: Seth
authors.forename: Corey
authors.initials: C
authors.lastname: Vasisko
authors.forename: Kevin
authors.initials: K
authors.lastname: Stimson