Ambulance ramping has been linked to an increased risk of death within 30 days. 

Researchers have analysed data from 213,544 adults with non-traumatic chest pain transported by ambulance to Victorian emergency departments (EDs) over four years. 

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

One of the major findings was 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. 

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”, according to the study. 

“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,” the researchers say.

“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,” the experts conclude. 

The full study is accessible here.