A review on ambulance offload delay literature

Area of Science:

• Emergency Medicine
• Healthcare Operations Research
• Public Health Policy

Background:

• Ambulance offload delay (AOD) arises when emergency department (ED) congestion prevents immediate patient transfer from paramedics.
• AOD is a growing concern for healthcare providers, researchers, and practitioners.
• Existing research often focuses on broader ED crowding and ambulance diversion, with limited studies dedicated solely to AOD.

Purpose of the Study:

• To systematically review and synthesize existing literature on ambulance offload delay (AOD).
• To analyze the causes, impacts, and interventions related to AOD.
• To identify research gaps and provide recommendations for future AOD mitigation strategies.

Main Methods:

• A comprehensive literature review was conducted, analyzing 137 articles.
• Articles were categorized based on their focus: problem understanding, causes/impacts, and interventions.
• Interventions were further classified into ambulance diversion and other strategies.

Main Results:

• Limited research specifically targets AOD, though related areas like ED crowding are more explored.
• Of the reviewed articles, 28 studied AOD causes, 14 its effects, and 89 proposed solutions.
• Ambulance diversion was the most common intervention, but yielded controversial results.

Conclusions:

• AOD is a complex issue with clinical, operational, and administrative dimensions, necessitating system-wide solutions.
• Future research should focus on system-wide interventions, addressing root causes of ED crowding, and developing better evaluation models for AOD mitigation.
• Improved AOD measurement is crucial for accurately assessing the problem's scale and impact.