The effects of ambulance ramping on Emergency Department length of stay and in-patient mortality

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Title The effects of ambulance ramping on Emergency Department length of stay and in-patient mortality
Author Hitchcock, Maree; Crilly, Julia Louise; Gillespie, Brigid Mary; Chaboyer, Wendy; Tippett, Vivienne; Lind, James
Journal Name Australasian Emergency Nursing Journal
Year Published 2010
Place of publication Australia
Publisher Elsevier
Abstract Background Ambulance ramping within the Emergency Department (ED) is a common problem both internationally and in Australia. Previous research has focused on various issues associated with ambulance ramping such as access block, ED overcrowding and ambulance bypass. However, limited research has been conducted on ambulance ramping and its effects on patient outcomes. Methods A case-control design was used to describe, compare and predict patient outcomes of 619 ramped (cases) vs. 1238 non-ramped (control) patients arriving to one ED via ambulance from 1 June 2007 to 31 August 2007. Cases and controls were matched (on a 1:2 basis) on age, gender and presenting problem. Outcome measures included ED length of stay and in-hospital mortality. Results The median ramp time for all 1857 patients was 11 (IQR 6–21) min. Compared to non-ramped patients, ramped patients had significantly longer wait time to be triaged (10 min vs. 4 min). Ramped patients also comprised significantly higher proportions of those access blocked (43% vs. 34%). No significant difference in the proportion of in-hospital deaths was identified (2% vs. 3%). Multivariate analysis revealed that the likelihood of having an ED length of stay greater than eight hours was 34% higher among patients who were ramped (OR 1.34, 95% CI 1.06–1.70, p = 0.014). In relation to in-hospital mortality age was the only significant independent predictor of mortality (p < 0.0001). Conclusion Ambulance ramping is one factor that contributes to prolonged ED length of stay and adds additional strain on ED service provision. The potential for adverse patient outcomes that may occur as a result of ramping warrants close attention by health care service providers. Keywords: Ambulance ramping; Emergency Department; Outcomes; Prehospital
Peer Reviewed Yes
Published Yes
Alternative URI http://dx.doi.org/10.1016/j.aenj.2010.02.004
Volume 13
Issue Number 1-2
Page from 17
Page to 24
ISSN 1574-6267
Date Accessioned 2010-07-02
Date Available 2010-09-21T06:56:24Z
Language en_AU
Research Centre Centre for Health Practice Innovation; Griffith Health Institute
Faculty Griffith Health Faculty
Subject Clinical Nursing: Secondary (Acute Care)
URI http://hdl.handle.net/10072/32204
Publication Type Journal Articles (Refereed Article)
Publication Type Code c1

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