Int J Emerg Med. 2025 Nov 26. doi: 10.1186/s12245-025-01068-y. Online ahead of print.
ABSTRACT
BACKGROUND: Ambulance offload delay (AOD) indicates the persistent and increasingly visible problem of Emergency Department (ED) crowding. AOD is defined as the extended time from ambulance arrival at the ED until patient care is transferred to ED staff. Despite its negative consequences and international attention, AOD is currently not monitored within the Dutch Emergency Care. It is also unknown whether or not AOD is associated with the ambulance diversion (AD) status. In the Dutch ED the AD status is monitored by means of the traffic light system. This study aims to monitor AOD at the EDs of Franciscus Gasthuis & Vlietland (FGV).
METHODS: A 10-week observational study was conducted at both the EDs of FGV. Ambulance personnel was queried regarding AOD duration and traffic light statuses by means of paper questionnaires. Descriptive statistics are reported as frequencies, medians and interquartile ranges (IQR). Associations between the traffic light status and categorical AOD data were analyzed using Chi-square tests.
RESULTS: During the study period, 2967 ambulances arrived at the EDs. In 229 cases (7.7%), the definition of AOD was met. The median AOD was 16 min (IQR: 10-25 min). In 95.6% (n = 2830) of the cases the handover time was less than 15 min. No statistically significant association was found between the traffic light status (green, orange, red) and offload delay categories (p = 0.109). A non-significant difference remained (p = 0.075) when comparing median AOD in the absence of an AD with the median AOD during an (impending) AD.
CONCLUSION: This is the first observational study conducted in the Netherlands collecting data regarding the AOD. The limited observation period, the reliance of self-reported data and the single-center design restricts the generalizability of the data. Consequently, the authors conclude hypothesis-generating findings which warrant validation through planned multicenter research. Nevertheless, besides the existing traffic light system, this unique study provides policy makers with a candidate complementary quality indicator for ED-crowding in the Dutch context.
PMID:41299224 | DOI:10.1186/s12245-025-01068-y
