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Published (Version of record)CC BY V4.0, Open Access
Published (Version of record)CC BY V4.0, Open
Journal article
Improving emergency department transfer for patients arriving by ambulance: A retrospective observational study
Emergency Medicine Australasia, Vol.32(2), pp.271-280
04/2020
PMCID: PMC7155107
PMID: 31867883
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Source: InCites
Abstract
Extended delays in the transfer of patients from ambulance to ED can compromise patient flow. The present study aimed to describe the relationship between the use of an Emergency Department Ambulance Off-Load Nurse (EDAOLN) role, ED processes of care and cost effectiveness.
This was a retrospective observational study over three periods of before (T1), during (T2) and after (T3) the introduction of the EDAOLN role in 2012. Ambulance, ED and cost data were linked and used for analysis. Processes of care measures analysed included: time to be seen by a doctor from ED arrival (primary outcome), ambulance-ED offload compliance, proportion of patients seen within recommended triage timeframe, ED length of stay (LoS), proportion of patients transferred, admitted or discharged from the ED within 4 h and cost effectiveness.
A total of 6045 people made 7010 presentations to the ED by ambulance over the study period. Several measures improved significantly between T1 and T2 including offload compliance (T1: 58%; T2: 63%), time to be seen (T1: 31 min; T2: 28 min), ED LoS (T1: 335 min; T2: 306 min), ED LoS <4 h (T1: 31%; T2: 33%). Some measures carried over into T3, albeit to a lesser extent. Post-hoc analyses showed that outcomes improved most for less urgent patients. The annualised net cost of the EDAOLN (if funded from additional resources) of $130 721 could result in an annualised reduction of approximately 3912 h in waiting time to be seen by a doctor.
With the EDAOLN role in place, slight outcome improvements in several key ambulance and ED efficiency criteria were noted. During times of ED crowding, the EDAOLN role may be one cost-effective strategy to consider.
Details
- Title
- Improving emergency department transfer for patients arriving by ambulance: A retrospective observational study
- Creators
- Julia Crilly - Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, AustraliaAmy Nb Johnston - School of Nursing, Midwifery and Social Work, The University of Queensland, Woolloongabba, Queensland, AustraliaMarianne Wallis - School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, Queensland, AustraliaJohn O'Dwyer - Australian eHealth Research Centre, Herston, Queensland, AustraliaJoshua Byrnes - School of Medicine, Griffith University Nathan Campus, Brisbane, Queensland, AustraliaPaul Scuffham - School of Medicine, Griffith University Nathan Campus, Brisbane, Queensland, AustraliaPing Zhang - Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, AustraliaEmma Bosley - Office of the Commissioner, Queensland Ambulance Service, Department of Health, Brisbane, Queensland, AustraliaWendy Chaboyer - Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, AustraliaDavid Green - School of Medicine, Griffith University Nathan Campus, Brisbane, Queensland, Australia
- Publication Details
- Emergency Medicine Australasia, Vol.32(2), pp.271-280
- Publisher
- Wiley-Blackwell Publishing Asia; Australia
- Grants
- EMSS000117, Emergency Medicine Foundation
- Grant note
- The present study was funded by an Emergency Medicine Foundation (formerly Queensland Emergency Medicine Research Foundation) (EMSS000117) project grant.
- Identifiers
- 991012926994902368
- Copyright
- This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Academic Unit
- Nursing; Faculty of Health
- Language
- English
- Resource Type
- Journal article