This report finds that ambulances in New South Wales wait longer at hospital emergency departments today than in previous years.
The Ambulance Service of New South Wales plays an important role in our health system. Its paramedics provide frontline emergency care to the community. They treat sick and injured patients at the scene of an emergency, and if necessary, take them to hospital emergency departments.
However ambulances sometimes get delayed at hospitals. Most often it is because paramedics are unable to move their patient into a bed in the emergency department. When this happens they wait with their patient on the ambulance stretcher until a bed becomes available.
There are many causes of ambulance delays. Increasing demand for hospital services, both emergency and inpatient care, can limit hospital capacity and cause overcrowding in the emergency department, particularly during winter. The Ministry of Health reports that since 2005-06 emergency department presentations have grown at almost three times the population rate. And ambulance arrivals have grown more, at over four times the population rate.
Furthermore, there are often patients in the emergency department who are waiting for beds to become available in hospital wards. This limits the number of beds in the emergency department making it harder for paramedics to off-load their patients when they arrive.
It is important that paramedics spend as little time as possible at emergency departments so they can respond to other triple-zero calls in the community. Even a five minute delay might mean the difference between life and death for someone waiting for an ambulance.
The Ministry of Health, Ambulance Service, and Local Health Districts acknowledge the problem and have put a number of strategies in place to reduce delays. A key aim of the Minister for Health’s 2012 ambulance reforms, Reform Plan for NSW Ambulance, is to release ambulances more promptly.
NSW Health requires hospitals to off-stretcher or transfer 90 per cent of ambulance patients into their care within 30 minutes. The total time spent by ambulance crews at emergency departments is called turnaround time, and also includes the time spent by paramedics getting ready to respond to the next job.
This audit assessed whether there are effective strategies in place to reduce the time spent by ambulance crews at emergency departments. We answered the following questions:
- do NSW Health’s strategies to reduce ambulance delays at emergency departments free up ambulances to respond to other incidents?
- do the Ambulance Service’s demand management strategies limit the number of patients it takes to emergency departments?
To help us answer these questions we analysed key performance data and reviewed statewide policies and procedures relevant to this issue. We interviewed over 100 staff across six hospitals and five ambulance sector offices to get their views on ambulance delays and observe how strategies to reduce delays work in practice. We also examined approaches in other jurisdictions.
We found that ambulances wait longer at hospital emergency departments today than in previous years. Each day the Ambulance Service loses an average of 18 ambulances on the road due to hospital delays greater than 30 minutes, potentially costing $13.6 million annually to replace. This is an increase from six ambulance crews seven years ago. NSW Health has never met its target to offload 90 per cent of ambulance patients in 30 minutes. Therefore initiatives to reduce delays have had limited impact statewide.
However the results for individual hospitals varied. In 2011-12 just over a quarter of NSW hospitals met the off-stretcher target. Others did not meet the target, but recently improved performance. Therefore strategies put in place by some hospitals to reduce delays are working.
We found that the Ambulance Service’s demand management strategies limit the number of patients transported to emergency departments. However these strategies are not used to their full potential. There is further scope for the Ambulance Service to reduce unnecessary transports to hospitals.