title: Can emergency medical services use turnaround time as a proxy for measuring ambulance offload time?
abstract: BACKGROUND
  "Offload delay" occurs when the transfer of care from paramedics to the emergency department (ED) is prolonged. Accurately measuring the delivery interval or "offload" is important, because it represents the time patients are waiting for definitive care. Because recording this interval presents a significant challenge, most emergency medical services systems only measure the complete at-hospital time or "turnaround interval," and most offload delay research and policy is based on this proxy.
  
  
  OBJECTIVE
  This study sought to test the validity of using the turnaround interval as a surrogate for the delivery interval.
  
  
  METHODS
  This observational study examined levels of correspondence, or correlation, between delivery interval and turnaround interval, to assess whether turnaround is a reasonable surrogate for delivery. Delivery and turnaround intervals were logged by Richmond Ambulance Authority (RAA) in Richmond, Virginia, United States from April 1 to December 31, 2008. A total of 1732 ambulance runs from RAA were included.
  
  
  RESULTS
  Pearson's correlation analysis showed a good correlation between turnaround and actual offload time (delivery), with a coefficient (r) of 0.753. A post hoc analysis explored patterns in the relationship, which is quite complex.
  
  
  CONCLUSIONS
  The results show that the correlation between the delivery and turnaround intervals is good. However, there remains much to be learned about the at-hospital time intervals and how to use these data to make decisions that will improve resource utilization and patient care. Efforts to establish a method to accurately record the delivery interval and to understand the at-hospital portion of the ambulance response are necessary.
authors.affiliation: Emergency Health Services - Nova Scotia, Halifax, Nova Scotia, Canada; Department of Emergency Medicine, Dalhousie University School of Medicine, Halifax, Nova Scotia, Canada.
authors.forename: Alix J E
authors.initials: AJ
authors.lastname: Carter
authors.affiliation: Richmond Ambulance Authority, Richmond, Virginia.
authors.forename: Jerry
authors.initials: J
authors.lastname: Overton
authors.affiliation: Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Terashima
authors.affiliation: Section of EMS, Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: David C
authors.initials: DC
authors.lastname: Cone
mesh_terms: D000552:Ambulances / Q000458:organization & administration* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D062209:Patient Handoff / Q000706:statistics & numerical data*; D013223:Statistics as Topic; D013997:Time Factors; D061665:Time-to-Treatment
keywords: crowding; emergency medical services; emergency medical technicians; emergency service; hospital