{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:11:25Z","timestamp":1788790285546,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100010230","name":"Queensland Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010230","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001078","name":"Emergency Medicine Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001078","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015674","name":"Queensland Ambulance Service","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015674","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the characteristics of ambulance ramping and its association with access block before, during and after the first wave of the coronavirus disease 2019 (COVID\u201019) pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Exploratory data analysis and statistical modelling covering the ambulance\u2013emergency department (ED) interface of the 25 largest public hospitals in Queensland between 1 January 2018 and 31 December 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Primary outcome: The association between ramping, assessed as the ambulance performance target patient off\u2010stretcher time (POST) and access block, and how COVID\u201019 affected these time\u2010sensitive processes. Secondary outcomes: The association between POST and ambulance response time and between ramping and ED length of stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A significant decline in POST performance was observed across the study period, with the mean difference between pre\u2013 and post\u2013COVID\u201019 periods being 13.1\u2009min (95% CI, 12.9\u201313.3\u2009min) and 8.9\u2009min (95% CI, 8.7\u20139.1\u2009min) for Priority 1 and Priority 2 responses, respectively. POST compliance within 30\u2009min dropped from 74% (718,912) pre\u2013COVID\u201019 to 66% (694,633) during the first wave of COVID\u201019 and 57% (309,815) post\u2013COVID\u201019, all below the 90% target. The proportion of patients experiencing access block increased from 10% (91,168) to 17% (87,757) over this same time period. Regression analyses revealed a positive relationship between POST and access block, response time and POST, and ramping and ED length of stay. Before COVID\u201019, no significant relationship existed between POST and access block for triage category 1 patients, but longer POST was linked to a higher likelihood of access block for categories 2\u20135. This trend increased across all categories during and post\u2013COVID\u201019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Achieving the POST target of transferring 90% of patients within 30\u2009min is becoming more difficult, with performance declining. The strong association of POST with access block suggests that access block is driving ramping increases. To reduce delays, efforts should focus on improving access to ward beds and managing hospital capacity issues.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5694\/mja2.70141","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T11:20:22Z","timestamp":1770722422000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Association Between Access Block And Ambulance Ramping, And The Impact of\n                    <scp>COVID<\/scp>\n                    \u201019: A Retrospective Observational Cohort Study of 25 Queensland Hospitals"],"prefix":"10.5694","volume":"224","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1772-7911","authenticated-orcid":false,"given":"Hwan\u2010Jin","family":"Yoon","sequence":"first","affiliation":[{"name":"Australian e\u2010Health Research Centre, CSIRO  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Boyle","sequence":"additional","affiliation":[{"name":"Australian e\u2010Health Research Centre, CSIRO  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahima","family":"Diouf","sequence":"additional","affiliation":[{"name":"Australian e\u2010Health Research Centre, CSIRO  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Bosley","sequence":"additional","affiliation":[{"name":"Queensland Ambulance Service  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Staib","sequence":"additional","affiliation":[{"name":"Princess Alexandra Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6050-6423","authenticated-orcid":false,"given":"Vahid","family":"Riahi","sequence":"additional","affiliation":[{"name":"Australian e\u2010Health Research Centre, CSIRO  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2315-1963","authenticated-orcid":false,"given":"Hamed","family":"Hassanzadeh","sequence":"additional","affiliation":[{"name":"Australian e\u2010Health Research Centre, CSIRO  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahnaz","family":"Samadbeik","sequence":"additional","affiliation":[{"name":"Queensland Digital Health Centre University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clair","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Princess Alexandra Hospital  Brisbane Queensland Australia"},{"name":"Queensland Digital Health Centre University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sankalp","family":"Khanna","sequence":"additional","affiliation":[{"name":"Australian e\u2010Health Research Centre, CSIRO  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Lind","sequence":"additional","affiliation":[{"name":"Gold Coast University Hospital  Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Canadian Agency for Drugs and Technologies in Health \u201cEmergency Department Overcrowding in Canada: CADTH Health Technology Review Recommendation \u201dOttawa (ON): Canadian Agency for Drugs and Technologies in Health 2023 accessed June 2024 https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK599980."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10091625"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n2835"},{"key":"e_1_2_11_5_1","unstructured":"American College of Emergency Physicians. 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