Offload zones to mitigate emergency medical services (EMS) offload delay in the emergency department: a process map and hazard analysis.

Content Provider	Semantic Scholar
Author	Carter, Alix J. E. Gould, James Barton Vanberkel, Peter T. Jensen, Jan Lars Cook, Jolene Carrigan, Steven Wheatley, Mark R. Travers, Andrew H.
Copyright Year	2015
Abstract	UNLABELLED Introduction Offload delay is a prolonged interval between ambulance arrival in the emergency department (ED) and transfer of patient care, typically occurring when EDs are crowded. The offload zone (OZ), which manages ambulance patients waiting for an ED bed, has been implemented to mitigate the impact of ED crowding on ambulance availability. Little is known about the safety or efficiency. The study objectives were to process map the OZ and conduct a hazard analysis to identify steps that could compromise patient safety or process efficiency. METHODS A Health Care Failure Mode and Effect Analysis was conducted. Failure modes (FM) were identified. For each FM, a probability to occur and severity of impact on patient safety and process efficiency was determined, and a hazard score (probability X severity) was calculated. For any hazard score considered high risk, root causes were identified, and mitigations were sought. RESULTS The OZ consists of six major processes: 1) patient transported by ambulance, 2) arrival to the ED, 3) transfer of patient care, 4) patient assessment in OZ, 5) patient care in OZ, and 6) patient transfer out of OZ; 78 FM were identified, of which 28 (35.9%) were deemed high risk and classified as impact on patient safety (n=7/28, 25.0%), process efficiency (n=10/28, 35.7%), or both (n=11/28, 39.3%). Seventeen mitigations were suggested. CONCLUSION This process map and hazard analysis is a first step in understanding the safety and efficiency of the OZ. The results from this study will inform current policy and practice, and future work to reduce offload delay.
Starting Page	489
Ending Page	494
Page Count	6
File Format	PDF HTM / HTML
Alternate Webpage(s)	https://www.cambridge.org/core/services/aop-cambridge-core/content/view/4D6C6A19EF342C3A4FC3D9B850A159A7/S1481803515000159a.pdf/offload_zones_to_mitigate_emergency_medical_services_ems_offload_delay_in_the_emergency_department_a_process_map_and_hazard_analysis.pdf
PubMed reference number	25994045v1
Alternate Webpage(s)	https://doi.org/10.1017/cem.2015.15
DOI	10.1017/cem.2015.15
Journal	CJEM
Volume Number	17
Issue Number	6
Language	English
Access Restriction	Open
Subject Keyword	Accident and Emergency department Ambulances Classification Ehlers-Danlos Syndrome Emergency medical service Erectile dysfunction Immunoprecipitation Liver Failure, Acute Memorial Sloan-Kettering Cancer Center Patients interest ounce
Content Type	Text
Resource Type	Article