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


CONCLUSIONS
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.
Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.|Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
Julia
J
Crilly
Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.|School of Medicine, Griffith University and Bond University, Gold Coast, Queensland, Australia.
Gerben
G
Keijzers
School of Clinical Science, Queensland University of Technology, Brisbane, Queensland, Australia.
Vivienne
V
Tippett
Australian eHealth Research Centre, CSIRO, Brisbane, Queensland, Australia.
John
J
O'Dwyer
Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
James
J
Lind
Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
Nerolie
N
Bost
Australian eHealth Research Centre, CSIRO, Brisbane, Queensland, Australia.
Marilla
M
O'Dwyer
Department of Emergency Medicine, Logan Hospital, Loganholme, Queensland, Australia.
Sue
S
Shiels
Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.|School of Nursing and Midwifery, University of Sunshine Coast, Maroochydore, Queensland, Australia.
Marianne
M
Wallis
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011793:Queensland; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D014218:Triage / Q000706:statistics & numerical data; D055815:Young Adult
ambulance; data linkage; emergency department; offload delay; outcome