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

Hitchcock, Maree; Crilly, Julia; Gillespie, Brigid; Chaboyer, Wendy; Tippett, Vivienne; Lind, James

doi:10.1016/j.aenj.2010.02.004

« Previous Next »Australasian Emergency Nursing Journal
Volume 13, Issue 1 , Pages 17-24, May 2010

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

Maree Hitchcock, RN, BN, MN(Emerg) (MAP(Hons))
- Griffith University, Gold Coast Campus, Parklands Drive, 4222 Queensland, Australia
- Griffith University Research Centre for Clinical and Community Practice Innovation, Gold Coast, Australia
- Corresponding author at: Research Centre for Clinical and Community Practice Innovation, Room 2.61, Clinical Sciences 2 Building (G16), Griffith University, Parklands Drive, Southport, 4215 Queensland, Australia. Tel.: +61 0422828882.
Julia Crilly, RN, BN, MN(Hons) (PhD)
- Griffith University, Gold Coast Campus, Parklands Drive, 4222 Queensland, Australia
- Griffith University Research Centre for Clinical and Community Practice Innovation, Gold Coast, Australia
- 108 Nerang Street, Southport, 4220 Queensland, Australia
- Southern District Emergency Department Clinical Network, Gold Coast Hospital, Australia
- Emergency Department, Gold Coast Hospital, Southport, Australia
Brigid Gillespie, RN, BHlth Sc( (Hons), PhD)
- Griffith University, Gold Coast Campus, Parklands Drive, 4222 Queensland, Australia
- Griffith University Research Centre for Clinical and Community Practice Innovation, Gold Coast, Australia
Wendy Chaboyer, RN, BSc, MN, PhD
- Griffith University, Gold Coast Campus, Parklands Drive, 4222 Queensland, Australia
- Griffith University Research Centre for Clinical and Community Practice Innovation, Gold Coast, Australia
Vivienne Tippett, BA, GradDip Psych, MPH
- School of Population Health, Herston Road, Herston, 4006 Queensland, Australia
- University of Queensland and Australian Centre for Prehospital Research, Queensland Ambulance Service, Queensland, Australia
James Lind, BM, BS, BMedSci, FACEM
- 108 Nerang Street, Southport, 4220 Queensland, Australia
- Southern District Emergency Department Clinical Network, Gold Coast Hospital, Australia
- Emergency Department, Gold Coast Hospital, Southport, Australia

Received 2 February 2010; received in revised form 10 February 2010; accepted 10 February 2010.

Summary

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 (10min vs. 4min). 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