Waiting time ambulances in the Emergency Department; a Dutch single center study (WAITED study)

Background Ambulance offload delay (AOD) indicates the persistent and increasingly visible problem of Emergency Department (ED) crowding. AOD is defined as the extended time from ambulance arrival at the hospital to the moment that patient care is transferred to ED staff. Despite its negative consequences and international attention, AOD is currently not monitored within the Dutch Emergency Care. It is also unknown whether or not AOD is associated with the ambulance diversion (AD) status. In the Dutch ED the AD status is monitored by means of the traffic light system. This study aims to monitor AOD at the EDs of Franciscus Gasthuis & Vlietland (FGV). Methods A 10-week observational study was conducted at the EDs of FGV. Ambulance personnel was queried regarding AOD duration and traffic light status by means of paper questionnaires. Descriptive statistics are reported as frequencies, medians and interquartile ranges (IQR). Associations between the traffic light status and categorical AOD data were analyzed using Chi-square tests. Results During the study period, 2967 ambulances arrived at the Eds. In 229 cases (7.7%), the definition of AOD was met. The median AOD was 16 minutes (IQR: 10–25 minutes). In 95.6% (n = 2830) of the cases the handover time was less than 15 minutes. No statistically significant association was found between the traffic light status (green, orange, red) and offload delay categories (p = 0.109). A non-significant difference remained (p = 0.075) when comparing median AOD in the absence of an ambulance diversion (green light) with the median AOD during an (impending) AD (orange and red combined). Conclusion This single-center study provides the first Dutch data on AOD and shows that over 95% of handovers met the internationally recommended 15-minute benchmark. Although overall incidence of AOD was low, most delays occurred during green light periods. No significant association was found between traffic light status and AOD, suggesting that AOD may reflect factors beyond the current traffic light classification and could serve as a complementary indicator for ED-crowding.