• Emerg Med Australas · Apr 2020

    Observational Study

    Improving emergency department transfer for patients arriving by ambulance: A retrospective observational study.

    • Julia Crilly, Amy Nb Johnston, Marianne Wallis, John O'Dwyer, Joshua Byrnes, Paul Scuffham, Ping Zhang, Emma Bosley, Wendy Chaboyer, and David Green.
    • Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.
    • Emerg Med Australas. 2020 Apr 1; 32 (2): 271-280.

    ObjectiveExtended 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.MethodsThis 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.ResultsA 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.ConclusionWith 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.© 2019 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

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