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Emergency Medicine Australasia

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Vol 26 (6 Issues in 2014)
Edited by: Geoff Hughes
Print ISSN: 1742-6731 Online ISSN: 1742-6723
Impact Factor: 1.22

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Medicine & Healthcare, Wiley-Blackwell


October 09, 2012

Ambulance patients frequently wait up to an hour at the ED because of overcrowding

Patients who are brought to hospital by ambulance frequently have to wait before being accepted into the treatment area in the hospital’s emergency department (ED) because of ED overcrowding.

Yet relatively little is known about the clinical handover process by which an ambulance delivers a patient to the ED.

A study to quantify these delays and investigate factors associated with them is published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine.

The study was conducted by Professor David Cone, professor of emergency medicine at Yale University in the United States, who was at the time a Senior Visiting Fellow at the University of New South Wales; Associate Professor Paul Middleton from the University of New South Wales; and Sadaf Marashi Pour from the NSW Ministry of Health. 

At the time of the study, Associate Professor Middleton was the Founding Director of the Ambulance Research Institute, Ambulance Service of New South Wales; Professor Cone was Visiting Research Fellow at the ARI; and Ms Marashi Pour was a biostatistical trainee.

The study recorded over 140,000 patients being transported during four months of 2009.

Clinical handover delay was found to be relatively common in New South Wales, with approximately one patient in 20 experiencing a delay of greater than 60 minutes between arrival at the ED via emergency medical services and handover to the care of ED staff, and another one in eight experiencing a delay of between 30 and 60 minutes.

The median handover interval was 15 minutes.

Patients transported to large hospitals were more likely to experience delays of up to 30 minutes 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 or over were more likely to experience delays than those under 16 years.

Delays were most likely in winter.

Cardiac and major trauma patients had the lowest likelihood of experiencing delays.

In parts of New South Wales, the scope of the problem is such that the Ambulance Service sends an Ambulance Release Team to the ED if there is one ambulance crew waiting more than 60 minutes, or two crews waiting more than 30 minutes, to handover patient care to the ED staff.  The Ambulance Release Team assumes the care of these patients in the hallway and releases the ambulance crews back to duty.