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Health Care Management Science Dec 2019Ambulance offload delay (AOD) occurs when care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency... (Review)
Review
Ambulance offload delay (AOD) occurs when care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency department (ED). This is typically due to emergency department congestion. This problem has become a significant concern for many health care providers and has attracted the attention of many researchers and practitioners. This article reviews literature which addresses the ambulance offload delay problem. The review is organized by the following topics: improved understanding and assessment of the problem, analysis of the root causes and impacts of the problem, and development and evaluation of interventions. The review found that many researchers have investigated areas of emergency department crowding and ambulance diversion; however, research focused solely on the ambulance offload delay problem is limited. Of the 137 articles reviewed, 28 articles were identified which studied the causes of ambulance offload delay, 14 articles studied its effects, and 89 articles studied proposed solutions (of which, 58 articles studied ambulance diversion and 31 articles studied other interventions). A common theme found throughout the reviewed articles was that this problem includes clinical, operational, and administrative perspectives, and therefore must be addressed in a system-wide manner to be mitigated. The most common intervention type was ambulance diversion. Yet, it yields controversial results. A number of recommendations are made with respect to future research in this area. These include conducting system-wide mitigation intervention, addressing root causes of ED crowding and access block, and providing more operations research models to evaluate AOD mitigation interventions prior implementations. In addition, measurements of AOD should be improved to assess the size and magnitude of this problem more accurately.
Topics: Allied Health Personnel; Ambulance Diversion; Ambulances; Crowding; Emergency Service, Hospital; Humans; Operations Research; Resource Allocation; Time Factors
PubMed: 29982911
DOI: 10.1007/s10729-018-9450-x -
Acta Anaesthesiologica Scandinavica Oct 2020
Topics: Air Ambulances; Aircraft; Ambulances; Emergency Medical Services; Emergency Service, Hospital; Humans
PubMed: 32691406
DOI: 10.1111/aas.13676 -
Emergency Medicine Journal : EMJ Nov 2013Occupational, social and recreational routines follow temporal patterns, as does the onset of certain acute medical diseases and injuries. It is not known if the... (Review)
Review
BACKGROUND
Occupational, social and recreational routines follow temporal patterns, as does the onset of certain acute medical diseases and injuries. It is not known if the temporal nature of injury and disease transfers into patterns that can be observed in ambulance demand. This review examines eligible study findings that reported temporal (time of day, day of week and seasonal) patterns in ambulance demand.
METHODS
Electronic searches of Medline and Cumulative Index of Nursing and Allied Health Literature were conducted for papers published between 1980 and 2011. In addition, hand searching was conducted for unpublished government and ambulance service documents and reports for the same period.
RESULTS
38 studies examined temporal patterns in ambulance demand. Six studies reported trends in overall workload and 32 studies reported trends in a subset of ambulance demand, either as a specific case type or demographic group. Temporal patterns in overall demand were consistent between jurisdictions for time of day but varied for day of week and season. When analysed by case type, all jurisdictions reported similar time of day patterns, most jurisdictions had similar day of week patterns except for out-of-hospital cardiac arrest and similar seasonal patterns, except for trauma. Temporal patterns in case types were influenced by age and gender.
CONCLUSIONS
Temporal patterns are present in ambulance demand and importantly these populations are distinct from those found in hospital datasets suggesting that variation in ambulance demand should not be inferred from hospital data alone. Case types seem to have similar temporal patterns across jurisdictions; thus, research where demand is broken down into case types would be generalisable to many ambulance services. This type of research can lead to improvements in ambulance service deliverables.
Topics: Ambulances; Health Services Needs and Demand; Humans; Time Factors; Workload
PubMed: 23184922
DOI: 10.1136/emermed-2012-201852 -
Annals of Emergency Medicine Nov 2020
Topics: Air Ambulances; Emergencies; Humans; United States
PubMed: 34842164
DOI: 10.1016/j.annemergmed.2020.09.447 -
Prehospital Emergency Care 2011The emergency medical services (EMS) system is a component of a larger health care safety net and a key component of an integrated emergency health care system. EMS... (Review)
Review
The emergency medical services (EMS) system is a component of a larger health care safety net and a key component of an integrated emergency health care system. EMS systems, and their patients, are significantly impacted by emergency department (ED) crowding. While protocols designed to limit ambulance diversion may be effective at limiting time on divert status, without correcting overall hospital throughput these protocols may have a negative effect on ED crowding and the EMS system. Ambulance offload delay, the time it takes to transfer a patient to an ED stretcher and for the ED staff to assume the responsibility of the care of the patient, may have more impact on ambulance turnaround time than ambulance diversion. EMS administrators and medical directors should work with hospital administrators, ED staff, and ED administrators to improve the overall efficiency of the system, focusing on the time it takes to get ambulances back into service, and therefore must monitor and address both ambulance diversions and ambulance offload delay. This paper is the resource document for the National Association of EMS Physicians position statement on ambulance diversion and ED offload time. Key words: ambulance; EMS; diversion; bypass; offload; delay.
Topics: Ambulances; Crowding; Emergency Medical Services; Guidelines as Topic; Hospital Bed Capacity; Humans; Time Factors; Transportation of Patients
PubMed: 21870947
DOI: 10.3109/10903127.2011.608871 -
Journal of Public Health Medicine Sep 2000Ambulance services produce a large quantity of data, which can yield valuable summary statistics. For strategic planning purposes, an economic framework is proposed, and...
BACKGROUND
Ambulance services produce a large quantity of data, which can yield valuable summary statistics. For strategic planning purposes, an economic framework is proposed, and the following four resource allocation questions are answered, using data from the Surrey Ambulance Service: (1) To satisfy government response time targets, how many additional ambulances will be required, ceteris paribus? (2) To minimize average response time (r*) with given resources, how should ambulances be rostered temporally? (3) Which innovations are worth undertaking? (4) How would an increase in demand affect r*?
METHODS
The 'Ambulance Response Curve' --the relation between response time and the number of available but not-in-use ambulances--is used to estimate how much r* will be reduced by deploying an additional ambulance. Estimating the marginal cost of an ambulance allows us to estimate the opportunity cost of each second of response time, and to compare the cost of three 'innovations' with that of increasing resources. The time savings of adding an extra ambulance at each of the 168 h of the week are examined.
RESULTS
In 1997-1998, r* was 8 min 52 s. An additional ambulance reduces r* by 8.9 s. Each reduction of 1 s in r* costs 28,000 pounds per year. Fourteen additional ambulances are required to meet response time targets if the 8.9 s reduction per ambulance is maintained. r* reduces by 4.6 s when ambulances are shifted from early mornings to Saturday evenings. Activation time reduces by 38 s when crews sit in their ambulances. A 1 min decrease in overall call time decreases r* by 1.1 s. Answering only 10 per cent of all calls reduces r* by 63 s. An increase of demand of 10 per cent increases r* by 7.8 s.
CONCLUSIONS
Ambulance services will be better able to determine which innovations are worth undertaking. Policy makers will be better placed to determine funding levels to achieve response time targets.
Topics: Ambulances; Costs and Cost Analysis; Emergencies; Health Care Rationing; Health Services Needs and Demand; Humans; Linear Models; Models, Theoretical; Organizational Innovation; Patient Transfer; Personnel Staffing and Scheduling; Time and Motion Studies; Triage; United Kingdom
PubMed: 11077918
DOI: 10.1093/pubmed/22.3.413 -
The American Journal of Emergency... Sep 2021The primary purpose of this study was to evaluate trends in ambulance utilization and costs among Medicare beneficiaries from 2007 to 2018. Community characteristics...
BACKGROUND
The primary purpose of this study was to evaluate trends in ambulance utilization and costs among Medicare beneficiaries from 2007 to 2018. Community characteristics associated with ambulance use and costs are also explored.
METHODS
Aggregated county-level fee-for-service (FFS) Medicare beneficiary claims data from 2007 to 2018 were used to assess ambulance transports per 1000 FFS Medicare beneficiaries and standardized inflation-adjusted ambulance costs. Multivariable linear mixed models were used to quantify trends in ambulance utilization and costs and to control for confounders.
RESULTS
A total of 37,675 county-years were included from 2007 to 2018. Ambulance transports per 1000 beneficiaries increased 15% from 299 (95% CI: 291.63, 307.30) to 345 (95% CI: 336.91, 353.10) from 2007 to 2018. Inflation-adjusted standardized per user costs exhibited an increasing (1.04, 95% CI: 1.04, 1.05), but non-linear relationship (0.996, 95% CI: 0.996, 0.996) over time with costs peaking in 2012. Indicators of lower socioeconomic status (SES) were associated with increases in both ambulance events and costs (p < .0001). A higher prevalence of Medicare beneficiaries utilizing Skilled Nursing Facilities was associated with increased levels of ambulance events per 1000 beneficiaries (95% CI: 8.06, 10.63). Rural location was associated with a 38% increase in ambulance costs (95% CI 1.30-1.47) compared to urban location.
CONCLUSIONS
Numerous policy solutions have been proposed to address growing ambulance costs in the Medicare program. While ambulance transports and costs continue to increase, a bend in the ambulance cost curve is detected suggesting that one or more policies altered Medicare ambulance costs, although utilization has continued to grow linearly. Ambulance use and costs vary significantly with community-level factors. As policy makers consider how to address growing ambulance use and costs, targeting identified community-level factors associated with greater costs and utilization, and their root causes, may offer a targeted approach to addressing current trends.
Topics: Aged; Ambulances; Emergency Medical Services; Female; Health Expenditures; Humans; Male; Medicare; Retrospective Studies; United States
PubMed: 33895702
DOI: 10.1016/j.ajem.2021.04.039 -
Journal of Clinical Nursing Jan 2019To explore ambulance nurses' (ANs) experiences of non-conveying patients to alternate levels of care.
AIMS AND OBJECTIVES
To explore ambulance nurses' (ANs) experiences of non-conveying patients to alternate levels of care.
BACKGROUND
Increases in ambulance utilisation and in the number of patients seeking ambulance care who do not require medical supervision or treatment during transport have led to increased nonconveyance (NC) and referral to other levels of care.
DESIGN
A qualitative interview study was conducted using an inductive research approach.
METHODS
The study was conducted in a region in the middle of Sweden during 2016-2017. Twenty nurses were recruited from the ambulance departments in the region. A conventional content analysis was used to analyse the interviews. The study followed the COREQ checklist.
RESULTS
The ANs experienced NC as a complex and difficult task that carried a large amount of responsibility. They wanted to be professional, spend time with the patient and find the best solution for him or her. These needs conflicted with the ANs' desire to be available for assignments with a higher priority. The ANs could feel frustrated when they perceived that ambulance resources were being misused and when it was difficult to follow the NC guidelines.
CONCLUSION
If ANs are expected to nonconvey patients seeking ambulance care, they need a formal mandate, knowledge and access to primary health care.
RELEVANCE TO CLINICAL PRACTICE
This study provides new knowledge regarding the work situation of ANs in relation to NC. These findings can guide future research and can be used by policymakers and ambulance organisations to highlight areas that need to evolve to improve patient care.
Topics: Ambulances; Emergency Medical Services; Female; Humans; Male; Needs Assessment; Nurse's Role; Nurses; Qualitative Research; Sweden
PubMed: 30016570
DOI: 10.1111/jocn.14626 -
Tidsskrift For Den Norske Laegeforening... Mar 2001
Topics: Ambulances; Emergency Medical Services; Humans; Norway
PubMed: 11332373
DOI: No ID Found -
American Journal of Surgery Oct 1959
Topics: Ambulances; Humans
PubMed: 13813384
DOI: 10.1016/0002-9610(59)90029-7