Rapid Offload to Avoid Delays to Mitigate Ambulance Patient Offload Time

Ambulance patient offload time, the interval from emergency medical service arrival to completion of transfer of care to emergency department personnel, is associated with delayed treatment, prolonged emergency medical service turnaround, and operational and financial strain. In California, ambulance patient offload time has received legislative attention through Assembly Bill 40, enacted to reduce ambulance offload delays, expedite care, and improve emergency medical service community response. This quality improvement project evaluated whether a dedicated ambulance receiving area, named Ambi ROAD (Rapid Offload to Avoid Delays) supported by a dedicated nurse and standardized staff workflow training, was associated with reduced ambulance patient offload time at a high-volume emergency department.

Using a retrospective pre-post observational design, monthly data from the 12 months before implementation were compared with those from the 12 months after implementation. The intervention was refined through multiple Plan-Do-Study-Act cycles. Monthly 90th percentile ambulance patient offload time values and ambulance arrival volumes were obtained from the 2 local emergency medical service agencies that served the site. Monthly ED census was also evaluated to assess utilization trends.

Mean monthly 90th percentile ambulance patient offload time decreased from 80.00 to 30.58 minutes for Sacramento County ambulance arrivals (t = 8.64, P < .001, d = 3.53) and from 81.58 to 33.67 minutes for Sierra-Sacramento Valley ambulance arrivals (t = 9.38, P < .001, d = 3.83). Ambulance traffic increased from 654.50 to 764.58 per month for Sacramento County (P < .001) and from 759.83 to 801.92 per month for Sierra-Sacramento Valley (P = .022). The emergency department census did not change significantly (P = .442).

A dedicated ambulance receiving area, a dedicated offload nurse, and standardized workflow training were associated with substantial reductions in ambulance patient offload time despite an increased ambulance volume. This approach may help emergency departments move toward regulatory targets, or similar aims, and support more timely initiation of patient care and faster emergency medical service turnaround.