Evaluation of ambulance offload delay at a university hospital emergency department.

BACKGROUND: Ambulance offload delay (AOD) has been recognized by the National Association of EMS Physicians (NAEMSP) as an important quality marker. AOD is the time between arrival of a patient by EMS and the time that the EMS crew has given report and moved the patient off of the EMS stretcher, allowing the EMS crew to begin the process of returning to service. The AOD represents a potential delay in patient care and a delay in the availability of an EMS crew and their ambulance for response to emergencies. This pilot study was designed to assess the AOD at a university hospital utilizing direct observation by trained research assistants. FINDINGS: A convenience sample of 483 patients was observed during a 12-month period. Data were analyzed to determine the AOD overall and for four groups of National Emergency Department Overcrowding Scale (NEDOCS) score ranges. The AOD ranged from 0 min to 157 min with a median of 11 min. When data were grouped by NEDOCS score, there was a statistically significant difference in median AOD between the groups (p < 0.001), indicating the relationship between ED crowding and AOD. CONCLUSION: The median AOD was considered significant and raised concerns related to patient care and EMS system resource availability. The NEDOCS score had a positive correlation with AOD and should be further investigated as a potential marker for determining diversion status or for destination decision-making by EMS personnel.

Chaperones for rectal and genital examinations in the emergency department: what do patients and physicians want?

BACKGROUND: The objective of this study was to compare patients' preferences and physicians' practice for the presence of chaperones during genitourinary examinations. METHODS: A survey of 163 emergency department patients and 52 physicians was used to evaluate patients' preferences and physicians' practices for the presence and gender of a chaperone during genital examinations. RESULTS: Most male patients (88%) did not care about the presence of a chaperone. Only 47% of female patients preferred a chaperone when a pelvic examination was to be performed by a male physician and only 26% preferred a chaperone with a female physician. One hundred percent of male and most female physicians (92%) used a chaperone for pelvic examinations. Most physicians do not ask patients whether they want a chaperone; however, most patients would like to be asked. CONCLUSIONS: We conclude there is a discrepancy between what physicians do and what their patients desire.