Declining Ambulance Offload Delays and Stabilised Emergency Department Length of Stay Post-COVID: An Interrupted Time Series Analysis.
Clinical and Experimental Emergency Medicine · 2026-04-03 · Quasi-experimental
Abstract
OBJECTIVE: Ambulance offload delays and emergency department [ED] crowding worsened during COVID-19 and remain critical in Victoria, where <62 % of ambulances offload on time. Evidence on post-pandemic trends is limited. We analysed offload delays and ED length of stay [LOS] at a major Melbourne health service [Jan 2018-Aug 2024] across three periods: pre-COVID, during COVID and post-COVID, stratified by admission status. METHODS: Monthly median offload times and ED LOS were examined using interrupted time-series models to detect level and slope changes. RESULTS: Among 529 261 presentations, median offload times for non-admitted patients increased 12.7 min at the post-COVID transition then fell 0.62 min per month, ending below pre-COVID projections. Admitted patients showed a median 14.2 min increase and a 0.73 min per month decline. ED LOS median time rose post-COVID by 53.6 min for non-admitted and 124.8 min for admitted patients. Thereafter, non-admitted patient LOS declined, whereas admitted patient LOS remained persistently elevated and stabilised at a high level. CONCLUSIONS: Although ambulance offload delays have improved, now below pre-COVID counterfactual levels, emergency department length of stay remains elevated particularly for admitted patients. Targeted interventions such as dedicated offload staff, real-time bed management, and streamlined discharge pathways are needed to address persistent emergency department crowding.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
COVID-19 pandemic · Offload delay & turnaround · Time intervals
Related articles
- The Association Between Access Block And Ambulance Ramping, And The Impact of COVID-19: A Retrospective Observational Cohort Study of 25 Queensland Hospitals. (Med J Aust, 2026)
- Elimination of Emergency Department Ambulance Divert during the COVID-19 Pandemic Was Not Associated with an Increase in the Average Number of Ambulance Arrivals per Day. (Prehosp Emerg Care, 2024)
- The Impact of the COVID-19 Pandemic on Demand for Emergency Ambulances in Victoria, Australia. (Prehosp Emerg Care, 2022)
- Machine learning-based forecasting of firemen ambulances' turnaround time in hospitals, considering the COVID-19 impact. (Appl Soft Comput, 2021)
- The Lombardy Emergency Medical System Faced with COVID-19: The Impact of Out-of-Hospital Outbreak. (Prehosp Emerg Care, 2021)
- Changes in urgent and emergency care activity associated with COVID-19 lockdowns in a sub-region in the East of England: Interrupted times series analyses. (PLoS One, 2024)