REDUCING INITIAL TRIAGE ASSESSMENT WAIT TIME OF EMERGENCY DEPARTMENT PATIENTS ON AMBULANCE OFFLOAD DELAY

Patients accessing the 9-1-1 system for emergency medical care and requiring ambulance transport expect the prompt transfer to and treatment at an emergency department (ED). Ineffective system input, throughput, and output flow processes contribute to ED overcrowding. Often this leads to ambulance offload delay (AOD), which is defined as a wait time of greater than 25 minutes. Patients on AOD do not receive an immediate triage nurse assessment, are often left untreated by ED personnel, and experience limited treatment options and oversight. To address this problem, a protocol was implemented to reduce time of emergency medical services (EMS) arrival time to initial triage assessment for patients transported by ambulance when AOD was anticipated to be greater than 25 minutes. To assess the effectiveness of the protocol in reducing time to triage assessment for AOD patients, data from patient records of 121 pre- and 132 post-protocol patients who were on AOD times for greater than 25 minutes were collected. A t-test and Mann-Whitney U test found no significance regarding EMS arrival to triage time between protocol groups. To avoid a Type I error, a chi-square test of independence was conducted to analyze protocol effectiveness when implemented correctly. One protocol compliant charge nurse and one non-compliant protocol charge nurse were compared. Results showed statistical significance for reducing the time of arrival to initial assessment when the protocol was correctly implemented (χ2(1) = 4.71, p = .030). The findings support the correct implementation of this protocol will reduce iv the time of EMS arrival to triage time in patients arriving by ambulance when AOD times were greater than 25 minutes. Ongoing evaluation of the protocol is in progress. Reducing time of arrival to time of triage will ultimately result in improved patient safety and outcomes