Kgbo, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons
Kgbo, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

Ambulance ramping linked to an increase risk of death within 30 days

Embargoed until: Publicly released:
Peer-reviewed: This work was reviewed and scrutinised by relevant independent experts.

Observational study: A study in which the subject is observed to see if there is a relationship between two or more things (eg: the consumption of diet drinks and obesity). Observational studies cannot prove that one thing causes another, only that they are linked.

People: This is a study based on research using people.

People with chest pain who spent more than 17 minutes ramped in an ambulance had a higher risk of dying in the next month, according to Victorian research. The study found that ambulance ramping times for people with chest pain have increased from 21 minutes in 2015 to 24 minutes during the first half of 2019. The authors say improving the speed of ambulance-to-ED transfers is urgently required.

Journal/conference: Medical Journal of Australia

Link to research (DOI): 10.5694/mja2.51613

Organisation/s: The Royal Melbourne Hospital, Monash University, Baker Heart and Diabetes Institute

Funder: The study was supported by Ambulance Victoria and the Alfred Health Department of Cardiology. We acknowledge the Victorian Department of Health as the source of Victorian Emergency Minimum Dataset and Victorian Admitted Episodes Dataset data, the Victorian Department of Justice and Community Safety as the source of Victorian Death Index data, and the Centre for Victorian Data Linkage (Victorian Department of Health) for providing data linkage. Luke Dawson is supported by National Health and Medical Research Council (NHMRC) and National Heart Foundation (NHF) postgraduate scholarships. Emily Andrew is supported by an NHMRC postgraduate scholarship, Jason Bloom by NHMRC and NHF postgraduate scholarships, Ziad Nehme by an NHMRC early career fellowship, Dion Stub by NHF grants, and Andrew Taylor by an NHMRC Investigator grant.

Media release

From: Medical Journal of Australia

AMBULANCE RAMPING ASSOCIATED WITH INCREASED 30-DAY RISK OF DEATH

LONGER ambulance offload times are associated with greater 30-day risks of death and ambulance re-attendance, according to Victorian research published today by the Medical Journal of Australia.

Researchers from Ambulance Victoria, Monash University, Royal Melbourne Hospital, Alfred Health, and the Baker Heart Research Institute analysed data from adults with non-traumatic chest pain transported by ambulance to Victorian emergency departments (EDs), 1 January 2015 – 30 June 2019. Patients with ST elevation myocardial infarction (on pre-hospital electrocardiography) and those who were transferred between hospitals or not transported to hospital (eg, cardiac arrest or death prior to transport) were excluded from the study.

“We included 213 544 people with chest pain transported by ambulance to EDs,” the authors, led by Dr Luke Dawson, a cardiologist at Alfred Health and Monash University, reported .

“The median offload time increased from 21 minutes in 2015 to 24 minutes during the first half of 2019.

“Three offload time tertiles were defined to include approximately equal patient numbers: tertile 1 (0‒17 minutes), tertile 2 (18‒28 minutes), and tertile 3 (more than 28 minutes).

“Thirty-day risk of death was greater for patients in tertile 3 than those in tertile 1 (adjusted rates, 1.57% v 1.29%), as was that of a second ambulance attendance with chest pain (adjusted rates, 9.03% v 8.15%).

“Our major findings are that the median offload time increased during 2015–19, that the risks of death and ambulance re-attendance with chest pain within 30 days of initial ED presentation were higher when the offload time exceeded 17 minutes, and that longer offload times were associated with presentations by people over 65 or women, at hospitals with larger total bed numbers, and presentation between 8 am and midnight, on weekdays, or during winter or spring,” Dawson and colleagues wrote.

Ambulance offload delays (“ramping”) have been associated with “prolonged ambulance response times, longer ED and hospital admission times, and cancellations of elective admissions and procedures that are probably caused by ED overcrowding and access block”.

“The impact of delays on patient outcomes is less clear; longer assessment and length of stay times have been reported, but discussion of their influence on clinical endpoints such as death has largely been limited to anecdotal reports in the mass media,” wrote Dawson and colleagues.

“Our findings should alert clinicians and health policymakers to the need for innovative strategies that reduce ambulance offload times. A key performance indicator for hospital performance in Victoria is the proportion of patients transferred from ambulance to ED within 40 minutes.

“As we found that mortality increased with times beyond 17 minutes, this target may be less appropriate than aiming to complete transfers within 15–20 minutes.

“Such a change to guidelines would be consistent with other jurisdictions, such as the United Kingdom, where the National Health Service requires handover of patients within 15 minutes of an ambulance arriving at an ED.

“Improving the speed of ambulance-to-ED transfers is urgently required,” Dawson and colleagues concluded.”

All MJA media releases are open access and can be found at: https://www.mja.com.au/journal/media

Please remember to credit The MJA.

The Medical Journal of Australia is a publication of the Australian Medical Association.

The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA or the MJA unless that is so stated.

Attachments:

Note: Not all attachments are visible to the general public

  • Wiley
    Web page
    Please link to the article in online versions of your report (the URL will go live after the embargo ends).

News for:

Australia
VIC

Media contact details for this story are only visible to registered journalists.