Monitoring of Ambulance Bypass

What is Ambulance Bypass?

An occasion of ambulance bypass is defined as a two hour time period during which ambulances bypass a specified emergency department at the request of that emergency department. During this period, the emergency department will continue to accept critical cases arriving by ambulance, as well as all patients arriving at the emergency department by other means. Non-time-critical ambulance patients are transported to the next nearest hospital emergency department.

A hospital may consider requesting a period of ambulance bypass when:

• the emergency department is full - it has reached its maximum physical capacity to safely accomodate and treat patients

• there are unexpected factors that mean the treatment of existing patients in the emergency department would be significantly compromised by the delivery of additional patients requiring emergency treatment - eg power failure, bomb threat

• necessary building or other works will temporarily reduce capacity (in this case the period of bypass is planned).

By far the most frequent reason for requesting bypass is that an emergency department is full.

Monitoring Ambulance Bypass

The Hospital Demand Management Group monitors the incidence of ambulance bypass in the thirteen major metropolitan public hospitals with emergency departments. The Group works closely with clinicians and administrators in the hospitals to ensure that bypass levels are kept as low as possible. Monthly targets are set, and hospitals have an incentive to achieve their targets.

In 1999, the frequency of ambulance bypass across Melbourne began to rise dramatically, due to increasing demand pressures across the health system. However, hospitals have worked hard to address this by implementing initiatives under the Hospital Demand Management Strategy and levels of ambulance bypass have been substantially reduced. In 2001/02 there were less than half the number of bypasses that occurred in 2000/01, and the level was also lower than in 1999/2000.

Ambulance bypass is reported to the public through the Hospital Services Report.

Why does Ambulance Bypass happen?

At the hospital level, there are a number of factors that can lead to an emergency department reaching its full capacity.

Some factors relate to the demand on the emergency department:

• Patients do not present to emergency departments in a constant stream - there are unpredictable peaks and troughs in the number of arrivals. Some periods will have unusually high numbers of presentations.
• Some patients have more urgent or more acute problems than others. Some periods will have particularly high levels of acuity.
• In some areas the hospital emergency department is one of the few local health care providers after hours and on weekends. At these times patients may come to the emergency department who would otherwise visit their GP.

Other factors relate to the demand on the hospital generally:

• Patients admitted to hospital from the emergency department require a bed in the hospital. Because the emergency department workload is unpredictable a bed may not be immediately available, and patients may have to wait in the emergency department until one becomes ready.
• Patients in the emergency department may need tests performed or periods of observation.

How are hospitals working to minimise Ambulance Bypass levels?

Since July 2001, hospitals have been implementing initiatives that form part of the Hospital Demand Management Strategy. These initiatives provide funding

• to treat extra patients
• to support clinicans to adopt innovative practices to enhance patient flow through the emergency department and other parts of the hospital
• to provide alternative options to being treated in a hospital bed
• for the Hospital Admission Risk Program: a range of innovative projects that will target people at risk of hospitalisation and provide for their care and management through an integrated approach involving both hospital and primary care services.