The Northern Hospital Ambulance offload performance improvement – nursing led, nursing driven, nursing success

Jodee Bootle1

1The Northern Hospital, Epping, Australia

The Victorian Department of Health and Human Services require hospitals to rapidly off-load emergency ambulance presentations, to maximise the availability of emergency response to our local community. The Statewide target is 90 per cent of patients transferred from an ambulance service into the care of the hospital in less than 40 minutes. Delivery on this Key Performance Indicator requires a careful balance between emergency department entry and exit, to ensure that a bed is always available for the next ambulance.

Northern Health has implemented an Ambulance Offload strategy which has resulted in significant and sustained improvement, becoming for the first time compliant for a continuous period of six months to present date. Our strategy involved distinct environmental, human resource and process changes, focussed on completing triage, allocation and handover within the 40-minute timeframe.

Environmental changes involved the designation of ambulance offload cubicles during times of peak demand, to create temporary buffer capacity to manage surges in demand. These three cubicles are fully staffed throughout our peak times, to enable offload, handover, and commence early assessment and management. Once occupied, an offload escalation strategy occurs, to ensure that these patients move to an assessment cubicle within 30mins of offload. This is achieved with prioritisation of admissions to ward, and expedition of discharges.

The keystone of this process change was effective accountability, governance and sustainability of proficient and efficient nursing care. The co-implementation of nursing role descriptions, daily performance monitoring, education via a triage self-review package to ensure quality and efficiency of triage as well ED nursing shift reports created staff accountability for this measure. Close monitoring enabled further development of our Ambulance offload process, which is now positioned in the highest performing services of our region.


Jodee Bootle explains nursing as her 3rd career after spending 10 years in the Army. After commencing nursing at the  the Royal Melbourne Hospital where she stayed for 13 years. After fulfilling various roles in ED, in Access as an After Hours Hospital Manager and the Nurse Unit Manager (NUM) for the Acute Medical Unit for 5 years. Jodee was the RMH Nurse of the Year for Leadership in 2013 and the recipient of the Hospira Research grant. In July 2016 she has moved to TNH.  She is currently the Nurse Unit Manager of The Northern Hospital (TNH) Emergency Department. Jodee is passionate about leading teams and implementing innovative processes for a sustainable future.