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Impacts of an EMS Hospital Liaison Program on Ambulance Offload Times: A Preliminary Analysis

Published online by Cambridge University Press:  02 December 2021

Becca M. Scharf Open the ORCID record for Becca M. Scharf [Opens in a new window] ,
Eric M. Garfinkel ,
David J. Sabat ,
Eric B. Cohn ,
Robert C. Linton  and
Matthew J. Levy
Becca M. Scharf*
Affiliation:
Howard County Department of Fire and Rescue Services, Marriottsville, MarylandUSA
Eric M. Garfinkel
Affiliation:
Howard County Department of Fire and Rescue Services, Marriottsville, MarylandUSA Department of Emergency Medicine, Johns Hopkins University, Baltimore, MarylandUSA
David J. Sabat
Affiliation:
Howard County Department of Fire and Rescue Services, Marriottsville, MarylandUSA
Eric B. Cohn
Affiliation:
Howard County Department of Fire and Rescue Services, Marriottsville, MarylandUSA
Robert C. Linton
Affiliation:
Department of Emergency Medicine, Johns Hopkins University, Baltimore, MarylandUSA
Matthew J. Levy
Affiliation:
Howard County Department of Fire and Rescue Services, Marriottsville, MarylandUSA Department of Emergency Medicine, Johns Hopkins University, Baltimore, MarylandUSA
*
Correspondence: Becca Scharf, MSc 2201 Warwick Way Marriottsville, Maryland 21104 USA E-mail: [email protected]
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Abstract

Introduction:

Ambulance patients who are unable to be quickly transferred to an emergency department (ED) bed represent a key contributing factor to ambulance offload delay (AOD). Emergency department crowding and associated AOD are exacerbated by multiple factors, including infectious disease outbreaks such as the coronavirus disease 2019 (COVID-19) pandemic. Initiatives to address AOD present an opportunity to streamline ambulance offload procedures while improving patient outcomes.

Study Objective:

The goal of this study was to evaluate the initial outcomes and impact of a novel Emergency Medical Service (EMS)-based Hospital Liaison Program (HLP) on ambulance offload times (AOTs).

Methods:

Ambulance offload times associated with EMS patients transported to a community hospital six months before and after HLP implementation were retrospectively analyzed using proportional significance tests, t-tests, and multiple regression analysis.

Results:

A proportional increase in incidents in the zero to <30 minutes time category after program implementation (+2.96%; P <.01) and a commensurate decrease in the proportion of incidents in the 30 to <60 minutes category (−2.65%; P <.01) were seen. The fully adjusted regression model showed AOT was 16.31% lower (P <.001) after HLP program implementation, holding all other variables constant.

Conclusion:

The HLP is an innovative initiative that constitutes a novel pathway for EMS and hospital systems to synergistically enhance ambulance offload procedures. The greatest effect was demonstrated in patients exhibiting potentially life-threatening symptoms, with a reduction of approximately three minutes. While small, this outcome was a statistically significant decrease from the pre-intervention period. Ultimately, the HLP represents an additional strategy to complement existing approaches to mitigate AOD.

Keywords

ambulance offload delayCOVID-19crowdingemergency departmentEmergency Medical Services
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 1 , February 2022 , pp. 45 - 50
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Cooney, DR, Millin, MG, Carter, A, Lawner, BJ, Nable, JV, Wallus, HJ. Ambulance diversion and emergency department offload delay: resource document for the National Association of EMS Physicians position statement. Prehosp Emerg Care. 2011;15(4):555–561.CrossRefGoogle ScholarPubMed
Morley, C, Unqin, M, Peterson, GM, Stankovich, J, Kingsman, L. Emergency department crowding: a systematic review of causes, consequences and solutions. PLoS One. 2018;13(8):1–43.CrossRefGoogle ScholarPubMed
Silvestri, S, Sun, J, Gutovitz, S, Ralls, G, Papa, L. An emergency department paramedic staffing model significantly improves EMS transport unit offload time: a novel approach to an ED crowding challenge. Emerg Med. 2014;1-6.Google Scholar
Li, M, Vanberkel, P, Carter, A. A review on ambulance offload delay literature. Health Care Manage Sci. 2019;22(4):658–675.CrossRefGoogle ScholarPubMed
Bost, N, Crilly, J, Wallis, M, Patterson, E, Chaboyer, W. Clinical handover of patients arriving by ambulance to the emergency department: a literature review. Int Emerg Nurs. 2010;18(4):210–220.CrossRefGoogle Scholar
Schull, MJ, Mamdani, MM, Fang, J. Community influenza outbreaks and emergency department ambulance diversion. Ann Emerg Med. 2004;44(1):61–67.CrossRefGoogle ScholarPubMed
Baugh, JJ, Yun, BJ, Searle, E, et al. Creating a COVID-19 surge clinic to offload the emergency department. Am J Emerg Med. 2020;38(7):1535–1537.CrossRefGoogle ScholarPubMed
Cooney, DR, Wojcik, S, Seth, N, Vasisko, C, Stimson, K. Evaluation of ambulance offload delay at a university hospital emergency department. Int J Emerg Med. 2013;6(15):1–4.CrossRefGoogle Scholar
Almehdawe, E, Jewkes, B, He, Q. Analysis and optimization of an ambulance offload delay and allocation problem. Omega. 2016;65:148–158.CrossRefGoogle Scholar
Crilly, J, Keijzers, G, Tippett, V, O’Dqyer, J, Lind, J, et al. Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed. Emerg Med Australas. 2015;27(3):216–224.10.1111/1742-6723.12399CrossRefGoogle Scholar
Maryland Institute for Emergency Medical Services Systems. The Maryland medical protocols for emergency medical services. EMS Clinician Protocols; July 1, 2021. https://www.miemss.org/home/ems-providers/protocols. Accessed July 14, 2021.Google Scholar
Amin, Q, Alqurashi, W, Perry, J, et al. Utility of an ambulance offload nurse on emergency department metrics. J Int Emerg Med. 2019;3(2):128–132.Google Scholar
Crilly, J, Johnston, ANB, Wallis, M, et al. Improving emergency department transfer for patients arriving by ambulance: a retrospective observational study. Emerg Med Australas. 2020;32(2):271–280.CrossRefGoogle ScholarPubMed
Burt, CW, McCaig, LF, Valverde, RH. Analysis of ambulance transports and diversions among US emergency departments. Ann Emerg Med. 2006;47(4):317–326.CrossRefGoogle ScholarPubMed
Greaves, T, Mitchell, M, Zhang, P, Crilly, J. The impact of an emergency department ambulance offload nurse role: a retrospective comparative study. Int Emerg Nurs. 2017;32:39–44.CrossRefGoogle ScholarPubMed