- Hwan-Jin Yoon, Justin Boyle, Ibrahima Diouf, Emma Bosley, Andrew Staib, Vahid Riahi, Hamed Hassanzadeh, Mahnaz Samadbeik, Clair Sullivan, Sankalp Khanna, James F. Lind
Correspondence: jin.yoon@csiro.au
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Abstract
Objective
To explore the characteristics of ambulance ramping and its association with access block before, during and after the first wave of the coronavirus disease 2019 (COVID-19) pandemic.
Design
Retrospective observational study.
Setting
Exploratory data analysis and statistical modelling covering the ambulance–emergency department (ED) interface of the 25 largest public hospitals in Queensland between 1 January 2018 and 31 December 2022.
Main Outcome Measures
Primary outcome: The association between ramping, assessed as the ambulance performance target patient off-stretcher time (POST) and access block, and how COVID-19 affected these time-sensitive processes. Secondary outcomes: The association between POST and ambulance response time and between ramping and ED length of stay.
Results
A significant decline in POST performance was observed across the study period, with the mean difference between pre– and post–COVID-19 periods being 13.1 min (95% CI, 12.9–13.3 min) and 8.9 min (95% CI, 8.7–9.1 min) for Priority 1 and Priority 2 responses, respectively. POST compliance within 30 min dropped from 74% (718,912) pre–COVID-19 to 66% (694,633) during the first wave of COVID-19 and 57% (309,815) post–COVID-19, all below the 90% target. The proportion of patients experiencing access block increased from 10% (91,168) to 17% (87,757) over this same time period. Regression analyses revealed a positive relationship between POST and access block, response time and POST, and ramping and ED length of stay. Before COVID-19, no significant relationship existed between POST and access block for triage category 1 patients, but longer POST was linked to a higher likelihood of access block for categories 2–5. This trend increased across all categories during and post–COVID-19.
Conclusion
Achieving the POST target of transferring 90% of patients within 30 min is becoming more difficult, with performance declining. The strong association of POST with access block suggests that access block is driving ramping increases. To reduce delays, efforts should focus on improving access to ward beds and managing hospital capacity issues.