Reducing Ambulance Turnaround Time at Hospitals

Ambulance delays at hospitals continue to be a challenge

"NSW Health has put in place initiatives to reduce the time ambulance crews have to wait at a hospital before they are able to leave and attend to other calls,” said Mr Achterstraat.

“This is encouraging, particularly as rising demand for hospital services continues to put pressure on our health system,” Mr Achterstraat added.

Despite these actions, ambulance crews are waiting longer at NSW hospitals. Crews now wait on average nearly 32 minutes (Exhibit 12) at a hospital before handing over a patient, up from about 24 minutes seven years ago.

Only 65 per cent of ambulance crews handed over patients within 30 minutes of arriving, well below NSW Health’s target of 90 per cent (exhibit 13). In 2011-12 nearly one in ten ambulances or around 50,000 patients waited longer than an hour to be moved from an ambulance stretcher into the care of the emergency department.

"If all delays of more than 30 minutes were eliminated there would be 18 more ambulance crews on the road. This is up from six crews seven years ago," said Mr Achterstraat.

“Paramedics should spend as little time as possible at emergency departments so they can respond to other triple-zero calls in the community," Mr Achterstraat said.

The good news is that some hospitals perform better than others. In 2011-12 over a quarter of NSW hospitals met the off-stretcher target. These were mainly small regional hospitals. Reducing ambulance delays is more challenging for larger, busier hospitals, often in metropolitan areas.

We also found that there is more scope to limit the number of patients taken by ambulance to hospital.

“The Ambulance Service has a number of strategies to reduce unnecessary transports to emergency departments – such as referring suitable triple-zero calls to advice lines and allowing paramedics to treat some health conditions at the scene,” Mr Achterstraat said. “However these are not being used to their full potential," he added.

This is exacerbated by unrealistic public expectations about the role of the Ambulance Service. Paramedics and hospital staff we spoke to said that some people thought:

• that taking an ambulance will fast-track you into hospital

• you can call an ambulance for minor ailments (exhibit 27).

“Calling triple-zero to get a script renewed or because you want your blood pressure checked is not appropriate,” Mr Achterstraat said.

Ultimately, hospitals need to move emergency department patients waiting for a hospital bed into their wards faster. One way to do this is to free up beds in the wards. Improved discharge practices to reduce unnecessary waits for drugs or review by inpatient doctors will help. But this requires all parts of a hospital to be responsible for ambulance delays.

"Paramedics should also be allowed to say ‘no’, that is, refuse to transport patients whose clinical assessment indicates that hospital treatment is not warranted," Mr Achterstraat concluded.

Barry Underwood, Executive Officer, on 9275 7220 or 0403 073 664