Chris Kingswell1, Ramon Z Shaban2, Julia Crilly3. 1. School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Fraser Coast Campus, 161 Old Maryborough Road, Hervey Bay, Qld, 4655, Australia. 2. School of Nursing and Midwifery, Griffith University, Health Sciences Building (N48), 170 Kessels Road, Nathan, Qld, 4111, Australia; Menzies Health Institute Queensland, Griffith University, Health Sciences Building (N48), 170 Kessels Road, Nathan, Qld, 4111, Australia; Department of Infection Control, Division of Infectious Diseases and Immunology, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, Qld, 4215, Australia. Electronic address: r.shaban@griffith.edu.au. 3. School of Nursing and Midwifery, Griffith University, Clinical Sciences 2 Building (G16), Parklands Drive, Southport, Qld, 4215, Australia; Menzies Health Institute Queensland, Griffith University, Health Sciences Building (N48), 170 Kessels Road, Nathan, Qld, 4111, Australia; Department of Emergency Medicine, Gold Coast Health, 1 Hospital Boulevard, Southport, Qld, 4215, Australia.
Abstract
BACKGROUND: Patients arriving at the Emergency Department (ED) via ambulance can experience a delay in receiving definitive care. In Australia, this phenomenon is referred to as 'Ambulance Ramping', 'Patient Off Stretcher Time Delay' or 'Offload Delay'. As a direct consequence of crowding, and in the context of a worldwide increase in ED and ambulance usage, hospital and ambulance service function is hampered. The aim of this review was to synthesize the literature with respect to the conceptualisation, meaning, antecedents and consequences of Ambulance Ramping. METHODS: This was a scoping review and synthesis of the literature. Six search terms were employed: emergency medical technician; paramedic; ambulance; hospital emergency services; delay; and ambulance ramping. Journal articles that discussed Ambulance Ramping (or similar terms), and were published in English between 1983 and March 2015 were included. PubMed and CINAHL Plus databases were searched, with secondary searches of reference lists and grey literature also undertaken. RESULTS: Thirteen papers were selected and inform this review. Several terms are used internationally to describe phenomena similar to Ambulance Ramping, where there is a delay in patient handover from paramedics to ED clinicians. Antecedents of Ambulance Ramping included reduction/limitation of ambulance diversion, patient acuity, the time of day, the day of the week, insufficient ED staff, insufficient ED beds, and high ED workload. Consequences of Ambulance Ramping include: further delays in patients' ability to receive definitive care and workforce stressors such as missed meal breaks, sick leave and staff attrition. CONCLUSION: While the existing research literature indicates that Ambulance Ramping is problematic, little is known about the patient's experience of Ambulance Ramping; this is required so that an enhanced understanding of its implications, including those for emergency nurses, can be identified.
BACKGROUND:Patients arriving at the Emergency Department (ED) via ambulance can experience a delay in receiving definitive care. In Australia, this phenomenon is referred to as 'Ambulance Ramping', 'Patient Off Stretcher Time Delay' or 'Offload Delay'. As a direct consequence of crowding, and in the context of a worldwide increase in ED and ambulance usage, hospital and ambulance service function is hampered. The aim of this review was to synthesize the literature with respect to the conceptualisation, meaning, antecedents and consequences of Ambulance Ramping. METHODS: This was a scoping review and synthesis of the literature. Six search terms were employed: emergency medical technician; paramedic; ambulance; hospital emergency services; delay; and ambulance ramping. Journal articles that discussed Ambulance Ramping (or similar terms), and were published in English between 1983 and March 2015 were included. PubMed and CINAHL Plus databases were searched, with secondary searches of reference lists and grey literature also undertaken. RESULTS: Thirteen papers were selected and inform this review. Several terms are used internationally to describe phenomena similar to Ambulance Ramping, where there is a delay in patient handover from paramedics to ED clinicians. Antecedents of Ambulance Ramping included reduction/limitation of ambulance diversion, patient acuity, the time of day, the day of the week, insufficient ED staff, insufficient ED beds, and high ED workload. Consequences of Ambulance Ramping include: further delays in patients' ability to receive definitive care and workforce stressors such as missed meal breaks, sick leave and staff attrition. CONCLUSION: While the existing research literature indicates that Ambulance Ramping is problematic, little is known about the patient's experience of Ambulance Ramping; this is required so that an enhanced understanding of its implications, including those for emergency nurses, can be identified.
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