The effects of ambulance ramping on Emergency Department length of stay and mortality

Abstract

Background: Ambulance ramping within the Emergency Department (ED) is a common problem
both internationally and in Australia. Previous research has focused on various issues associated
with ambulance ramping such as access block, ED overcrowding and ambulance bypass. However,
limited research has been conducted on ambulance ramping and its effects on patient
outcomes. ----- -----
Methods: A case-control design was used to describe, compare and predict patient outcomes
of 619 ramped (cases) vs. 1238 non-ramped (control) patients arriving to one ED via ambulance
from 1 June 2007 to 31 August 2007. Cases and controls were matched (on a 1:2 basis) on age,
gender and presenting problem. Outcome measures included ED length of stay and in-hospital
mortality. ----- -----
Results: The median ramp time for all 1857 patients was 11 (IQR 6—21) min. Compared to nonramped
patients, ramped patients had significantly longer wait time to be triaged (10 min vs.
4 min). Ramped patients also comprised significantly higher proportions of those access blocked
(43% vs. 34%). No significant difference in the proportion of in-hospital deaths was identified (2%vs. 3%). Multivariate analysis revealed that the likelihood of having an ED length of stay greater
than eight hours was 34% higher among patients who were ramped (OR 1.34, 95% CI 1.06—1.70,
p = 0.014). In relation to in-hospital mortality age was the only significant independent predictor
of mortality (p < 0.0001). ----- -----
Conclusion: Ambulance ramping is one factor that contributes to prolonged ED length of stay
and adds additional strain on ED service provision. The potential for adverse patient outcomes
that may occur as a result of ramping warrants close attention by health care service providers.