David C Cone, MD, was Honorary Research Fellow, Paul M Middleton, MBBS, MMed (Clin Epi), was Director, and Sadaf Marashi Pour, MSc, was Biostatistician at the Ambulance Research Institute, Ambulance Service of New South Wales, Australia at the time of this study.
Analysis and impact of delays in ambulance to emergency department handovers
Article first published online: 28 AUG 2012
© 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Emergency Medicine Australasia
Volume 24, Issue 5, pages 525–533, October 2012
How to Cite
Cone, D. C., Middleton, P. M. and Marashi Pour, S. (2012), Analysis and impact of delays in ambulance to emergency department handovers. Emergency Medicine Australasia, 24: 525–533. doi: 10.1111/j.1742-6723.2012.01589.x
- Issue published online: 8 OCT 2012
- Article first published online: 28 AUG 2012
- Manuscript Accepted: 22 JUN 2012
- allied health personnel;
- emergency medical services;
- emergency service;
- time factor
Delays 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.
A 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.
Of 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.
Handover 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.