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Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed

OBJECTIVE: To describe and compare characteristics and outcomes of patients who arrive by ambulance to the ED. We aimed to (i) compare patients with a delayed ambulance offload time (AOT) >30 min with those who were not delayed; and (ii) identify predictors of an ED length of stay (LOS) of >4...

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Autores principales: Crilly, Julia, Keijzers, Gerben, Tippett, Vivienne, O’Dwyer, John, Lind, James, Bost, Nerolie, O’Dwyer, Marilla, Shiels, Sue, Wallis, Marianne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676924/
https://www.ncbi.nlm.nih.gov/pubmed/25940975
http://dx.doi.org/10.1111/1742-6723.12399
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author Crilly, Julia
Keijzers, Gerben
Tippett, Vivienne
O’Dwyer, John
Lind, James
Bost, Nerolie
O’Dwyer, Marilla
Shiels, Sue
Wallis, Marianne
author_facet Crilly, Julia
Keijzers, Gerben
Tippett, Vivienne
O’Dwyer, John
Lind, James
Bost, Nerolie
O’Dwyer, Marilla
Shiels, Sue
Wallis, Marianne
author_sort Crilly, Julia
collection PubMed
description OBJECTIVE: To describe and compare characteristics and outcomes of patients who arrive by ambulance to the ED. We aimed to (i) compare patients with a delayed ambulance offload time (AOT) >30 min with those who were not delayed; and (ii) identify predictors of an ED length of stay (LOS) of >4 h for ambulance-arriving patients. METHODS: A retrospective, multi-site cohort study was undertaken in Australia using 12 months of linked health data (September 2007–2008). Outcomes of AOT delayed and non-delayed presentations were compared. Logistic regression analysis was undertaken to identify predictors of an ED LOS of >4 h. RESULTS: Of the 40 783 linked, analysable ambulance presentations, AOT delay of >30 min was experienced by 15%, and 63% had an ED LOS of >4 h. Patients with an AOT <30 min had better outcomes for: time to triage; ambulance time at hospital; time to see healthcare professional; proportion seen within recommended triage time frame; and ED LOS for both admitted and non-admitted patients. In-hospital mortality did not differ. Strong predictors of an ED LOS >4 h included: hospital admission, older age, triage category, and offload delay >30 min. CONCLUSION: Patients arriving to the ED via ambulance and offloaded within 30 min experience better outcomes than those delayed. Given that offload delay is a modifiable predictor of an ED LOS of >4 h, targeted improvements in the ED arrival process for ambulance patients might be useful.
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spelling pubmed-46769242015-12-20 Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed Crilly, Julia Keijzers, Gerben Tippett, Vivienne O’Dwyer, John Lind, James Bost, Nerolie O’Dwyer, Marilla Shiels, Sue Wallis, Marianne Emerg Med Australas Original Research OBJECTIVE: To describe and compare characteristics and outcomes of patients who arrive by ambulance to the ED. We aimed to (i) compare patients with a delayed ambulance offload time (AOT) >30 min with those who were not delayed; and (ii) identify predictors of an ED length of stay (LOS) of >4 h for ambulance-arriving patients. METHODS: A retrospective, multi-site cohort study was undertaken in Australia using 12 months of linked health data (September 2007–2008). Outcomes of AOT delayed and non-delayed presentations were compared. Logistic regression analysis was undertaken to identify predictors of an ED LOS of >4 h. RESULTS: Of the 40 783 linked, analysable ambulance presentations, AOT delay of >30 min was experienced by 15%, and 63% had an ED LOS of >4 h. Patients with an AOT <30 min had better outcomes for: time to triage; ambulance time at hospital; time to see healthcare professional; proportion seen within recommended triage time frame; and ED LOS for both admitted and non-admitted patients. In-hospital mortality did not differ. Strong predictors of an ED LOS >4 h included: hospital admission, older age, triage category, and offload delay >30 min. CONCLUSION: Patients arriving to the ED via ambulance and offloaded within 30 min experience better outcomes than those delayed. Given that offload delay is a modifiable predictor of an ED LOS of >4 h, targeted improvements in the ED arrival process for ambulance patients might be useful. John Wiley & Sons, Ltd 2015-06 2015-05-05 /pmc/articles/PMC4676924/ /pubmed/25940975 http://dx.doi.org/10.1111/1742-6723.12399 Text en © 2015 The Authors. Emergency Medicine Australasia published by Wiley Publishing Asia Pty Ltd on behalf of Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Crilly, Julia
Keijzers, Gerben
Tippett, Vivienne
O’Dwyer, John
Lind, James
Bost, Nerolie
O’Dwyer, Marilla
Shiels, Sue
Wallis, Marianne
Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed
title Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed
title_full Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed
title_fullStr Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed
title_full_unstemmed Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed
title_short Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed
title_sort improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676924/
https://www.ncbi.nlm.nih.gov/pubmed/25940975
http://dx.doi.org/10.1111/1742-6723.12399
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