When is a door not a door? The difference between documented and actual arrival times in the emergency department

Objectives: An observational study to determine the difference between documented ambulance arrival times and the actual arrival times of patients from the ambulance into the emergency department. Methods: In a busy, purpose built, modern emergency department with easy access, we recorded the time that ambulance borne patients were wheeled over the threshold of the clinical area and compared this to the times recorded by the ambulance trusts as the official ambulance arrival times. Results: 352 ambulance arrivals were observed. Data were incomplete in 34 instances (9.5%) and were not included in the analysis. For the remaining 318 arrivals, the median time difference was 2 min 1 s ( range 5 s to 21 min 45 s). In a subgroup of chest pain patients ( 45 patients), the median time difference was 2 min 11 s ( range 23 s to 5 min 38 s). The difference between the chest pain group and the remaining patients was not significant ( p = 0.528). Conclusions: There is inevitably some delay between the arrival of an ambulance and the arrival of the patient into a clinical area. This study quantifies that difference. In an era of stringent time related standards, this paper highlights the need for accurate recording of times to enable us to carry out valid audit of these standards. This study supports the redefining of an arrival time as the time when the patient arrives in the clinical area.