Health Care Management Science

, Volume 22, Issue 4, pp 658–675 | Cite as

A review on ambulance offload delay literature

  • Mengyu LiEmail author
  • Peter Vanberkel
  • Alix J. E. Carter


Ambulance offload delay (AOD) occurs when care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency department (ED). This is typically due to emergency department congestion. This problem has become a significant concern for many health care providers and has attracted the attention of many researchers and practitioners. This article reviews literature which addresses the ambulance offload delay problem. The review is organized by the following topics: improved understanding and assessment of the problem, analysis of the root causes and impacts of the problem, and development and evaluation of interventions. The review found that many researchers have investigated areas of emergency department crowding and ambulance diversion; however, research focused solely on the ambulance offload delay problem is limited. Of the 137 articles reviewed, 28 articles were identified which studied the causes of ambulance offload delay, 14 articles studied its effects, and 89 articles studied proposed solutions (of which, 58 articles studied ambulance diversion and 31 articles studied other interventions). A common theme found throughout the reviewed articles was that this problem includes clinical, operational, and administrative perspectives, and therefore must be addressed in a system-wide manner to be mitigated. The most common intervention type was ambulance diversion. Yet, it yields controversial results. A number of recommendations are made with respect to future research in this area. These include conducting system-wide mitigation intervention, addressing root causes of ED crowding and access block, and providing more operations research models to evaluate AOD mitigation interventions prior implementations. In addition, measurements of AOD should be improved to assess the size and magnitude of this problem more accurately.


Emergency medical service Offload delay Ambulance diversion Management science 



The authors thank Leah Boulos, Evidence Synthesis Coordinator at the Maritime SPOR SUPPORT Unit, for her support with the literature search and journal article extraction for this review.

Supplementary material

10729_2018_9450_MOESM1_ESM.pdf (392 kb)
ESM 1 (PDF 391 kb)


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Authors and Affiliations

  1. 1.Faculty of Engineering, Department of Industrial EngineeringDalhousie UniversityHalifaxCanada
  2. 2.Department of Emergency Medicine, Division of EMSDalhousie UniversityHalifaxCanada
  3. 3.Emergency Health ServicesDartmouthCanada
  4. 4.Nova Scotia Health AuthoritySydneyCanada

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