Ambulance offload delays in the Emergency Department – Is Age and Frailty a factor?

Introduction

Ambulance offload delays at the Emergency Department (ED) are linked to adverse outcomes. By 2030, 25% of patients attending the ED are projected to be over 80 years old. Geriatric frailty syndromes can be difficult for triage systems to assess, leading to older people being allocated lower priority status and a higher chance of a 4-hour target breach vs a younger patient(1). We assessed whether ambulance offload time is associated with frailty, death or re‐attendance at an emergency department at a large regional centre. Methods Retrospective analysis of adult ambulance offload data from February to June 2022 looking at age, frailty (CFS), inpatient length of stay (LOS), ED re-attendance within 6 months and death.

Results:

We included 1000 people transported by ambulance to ED February to June 2022. >65 years old– 622 patients (47% Male). Mean 406.3 minutes’ offload, CFS 5.4, LOS 11.75 days, Age 80.21 (IQR 73-87), 193 re-presented (32.76%), 135 deaths (22.9%). <65 - 378 patients (52.9% Male). Mean 189 minutes’ offload, LOS 5.1 days, Age 43.81 (IQR 33-56), 116 re-presented (31.86%), 24 deaths (6.34%). Significant associations (P<0.05) for CFS vs LOS, CFS vs Average offload, Average offload vs Age and LOS vs Average Offload. There is a significant link with Death vs CFS (P<0.05) but not re-presentation vs CFS.

Conclusions:

Longer ambulance offload times are associated with greater 6-month mortality and re‐attendance for people presenting to ED who are older and have increased frailty. Those directly offloaded to OPAS had decreased LOS (5.1 days) and offload time (121 minutes’) despite a mean CFS 6.41, indicating a need to increase OPAS capacity including for direct offloads into OPAS.