title: The lived experiences of patients and ambulance ramping in a regional Australian emergency department: An interpretive phenomenology study.
abstract: BACKGROUND
  Internationally, the workload of emergency departments (ED) has increased, resulting in overcrowding and frequent delays in the offloading of patients arriving via ambulance--referred to in Australia as 'ambulance ramping'.
  
  
  METHODS
  Using interpretive phenomenology, this study sought to understand the experience of ambulance ramping from the perspective of patients. Semi-structured interviews were undertaken with seven patients who presented to a regional Queensland ED via ambulance, and experienced an ambulance offload delay of >30 min.
  
  
  RESULTS
  Ambulance ramping in the ED was described as 'Being a patient, patient', and three major themes emerged: Understanding the emergency healthcare system; Making do within the emergency healthcare system; and Being 'in the dark' during ambulance ramping. Most participants did not understand the antecedents to ambulance ramping, but understood some of the consequences. Most were happy to wait with paramedics for a bed and, although without privacy, felt safe. However, most participants felt 'in the dark' during ambulance ramping, due to communication difficulties regarding bed availability, and this led to frustration.
  
  
  CONCLUSIONS
  In light of the Australian Charter of Healthcare Rights, service improvement opportunities exist for patients arriving to the ED by ambulance to ensure delays are minimised and quality care is delivered.
authors.affiliation: Emergency Department, Hervey Bay Hospital, Nissen Street, Urraween, Qld 4655, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Kingswell
authors.affiliation: Menzies Heath Institute, School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, Qld 4111, Australia; Infection Control Department, Gold Coast University Hospital, Gold Coast Hospital and Heath Service, 1 Hospital Boulevard, Southport, Qld 4215, Australia. Electronic address: r.shaban@griffith.edu.au.
authors.forename: Ramon Z
authors.initials: RZ
authors.lastname: Shaban
authors.affiliation: Menzies Heath Institute, School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, Qld 4111, Australia; Emergency Department, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, Qld 4215, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Crilly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000706:statistics & numerical data*; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062209:Patient Handoff / Q000706:statistics & numerical data*; D010361:Patients / Q000523:psychology*; D036301:Qualitative Research; D011793:Queensland / Q000453:epidemiology; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014218:Triage / Q000706:statistics & numerical data*
keywords: Ambulances; Emergency departments; Paramedics; Patients; Qualitative research