• Paul M Middleton, David C Cone, and Sadaf Marashi Pour.
• Section of EMS, Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. david.cone@yale.edu
• Emerg Med Australas. 2012 Oct 1;24(5):525-33.

ObjectivesDelays in the clinical handover of patient care from emergency medical services (EMS) to the ED because of ED crowding are a substantial problem for many EMS systems. This study was conducted to quantify handover delays experienced by the Ambulance Service of New South Wales (ASNSW), and to investigate patient and system factors associated with handover delay.MethodsA retrospective study of EMS dispatch and ambulance patient care records was conducted for all patients transported by ASNSW in January/April/July/October 2009. Patient characteristics and time intervals were summarised using descriptive statistics, with handover delay categorised as <30 min, 30-60 min and ≥60 min. Times are reported as HH:MM:SS. Partial proportional odds models were used to investigate factors associated with delays.ResultsOf 141 381 transports, 12.5% of patients experienced a handover delay of 30-60 min, and 5% a delay of ≥60 min. The median handover interval was 00:15:46 (IQR 00:08:58-00:24:52, maximum 08:43:13). Patients transported to large hospitals were more likely to experience a delay of ≥30 min (odds ratio [OR] 14.57, 95% CI 11.41-18.60) or ≥60 min (OR 15.75, 95% CI 12.27-20.23) 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 were more likely to experience delays than those <16 years. Delays were most likely in winter. Cardiac and major trauma patients had the lowest likelihood of experiencing delays.ConclusionsHandover delays are relatively common at the EMS/ED interface in New South Wales, and are most pronounced at large hospitals, in urban areas and during winter.© 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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