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The Association Between Access Block And Ambulance Ramping, And The Impact of COVID-19: A Retrospective Observational
Hwan-Jin Yoon1, Justin Boyle2, Ibrahima Diouf1
1Australian e-Health Research Centre, CSIRO, Melbourne, Victoria, Australia.
Insights
Ambulance ramping and patient off-stretcher time (POST) performance declined significantly during and after the COVID-19 pandemic. Access block appears to drive increased ambulance ramping, necessitating improved hospital capacity management.
Area of Science:
- Emergency Medicine
- Health Services Research
- Public Health Policy
Background:
- Ambulance ramping, defined as patient off-stretcher time (POST), is a critical indicator of emergency department (ED) efficiency.
- The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted healthcare systems globally, potentially affecting patient flow and ED performance.
- Access block, characterized by delays in admitting patients from the ED to inpatient beds, is a known contributor to ambulance ramping.
Purpose of the Study:
- To investigate the trends in ambulance ramping and its relationship with access block.
- To analyze the impact of the COVID-19 pandemic, specifically its first wave, on these emergency care processes.
- To explore the association between patient off-stretcher time (POST) and access block across different triage categories.
Main Methods:
- A retrospective observational study was conducted using data from the 25 largest public hospitals in Queensland.
- The study period spanned from January 1, 2018, to December 31, 2022, encompassing pre-pandemic, during, and post-pandemic periods.
- Exploratory data analysis and statistical modeling were employed to assess the association between POST, ambulance response times, access block, and ED length of stay.
Main Results:
- A significant decline in POST performance was observed, with compliance dropping from 74% pre-COVID-19 to 57% post-COVID-19, falling below the 90% target.
- The proportion of patients experiencing access block increased from 10% to 17% over the study period.
- Regression analyses confirmed a positive relationship between POST and access block, response time and POST, and ramping and ED length of stay, with trends worsening during and post-COVID-19.
Conclusions:
- Achieving the POST target is increasingly challenging, indicating a decline in ambulance performance.
- Access block is strongly associated with increased ambulance ramping, suggesting it is a primary driver of delays.
- Strategies to reduce ambulance ramping should prioritize improving inpatient bed access and managing hospital capacity.
Objective:
To explore the characteristics of ambulance ramping and its association with access block before, during and after the first wave of the coronavirus disease 2019 (COVID-19) pandemic.
Design:
Retrospective observational study.
Setting:
Exploratory data analysis and statistical modelling covering the ambulance-emergency department (ED) interface of the 25 largest public hospitals in Queensland between 1 January 2018 and 31 December 2022.
Main Outcome Measures:
Primary outcome: The association between ramping, assessed as the ambulance performance target patient off-stretcher time (POST) and access block, and how COVID-19 affected these time-sensitive processes.
Secondary Outcomes:
The association between POST and ambulance response time and between ramping and ED length of stay.
Results:
A significant decline in POST performance was observed across the study period, with the mean difference between pre- and post-COVID-19 periods being 13.1 min (95% CI, 12.9-13.3 min) and 8.9 min (95% CI, 8.7-9.1 min) for Priority 1 and Priority 2 responses, respectively. POST compliance within 30 min dropped from 74% (718,912) pre-COVID-19 to 66% (694,633) during the first wave of COVID-19 and 57% (309,815) post-COVID-19, all below the 90% target. The proportion of patients experiencing access block increased from 10% (91,168) to 17% (87,757) over this same time period. Regression analyses revealed a positive relationship between POST and access block, response time and POST, and ramping and ED length of stay. Before COVID-19, no significant relationship existed between POST and access block for triage category 1 patients, but longer POST was linked to a higher likelihood of access block for categories 2-5. This trend increased across all categories during and post-COVID-19.
Conclusion:
Achieving the POST target of transferring 90% of patients within 30 min is becoming more difficult, with performance declining. The strong association of POST with access block suggests that access block is driving ramping increases. To reduce delays, efforts should focus on improving access to ward beds and managing hospital capacity issues.
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