What Factors Could Create a More Comfortable Waiting Experience for Patients on Emergency Department Ramps? A Scoping Review

Abstract

Ambulance ramping is the situation where patients who arrive by ambulance are forced to queue for access to an emergency department (ED) cubicle. Despite efforts to address the problem of ambulance ramping, it continues to present a ubiquitous challenge for health services. While facility guidelines consider general healthcare and ED environments, evidence is lacking regarding necessary requirements to provide patient-centred care within the ramp environment. This scoping review identifies current research regarding characteristics of waiting environments that provide better experiences for consumers that may be transferable to the ambulance ramp. It utilises sources from both health and non-health literature to support outcomes. A systematic search of five electronic databases was conducted, reference chaining was undertaken, and grey literature was searched. Levels of evidence were assessed using the Mixed Methods Appraisal Tool. No study was found that specifically addressed the spatial layout of the ED ramp environment in relation to patient experience. Fifty-nine papers were included in the review. Papers underwent an inter-rater assessment regarding translatability of the outcomes to the ramp environment, including perceived complexity and cost. Outcomes with high inter-rater agreement were then discussed according to the domains of psychological, self-efficacy, social and functional. Elements categorised within these domains include privacy, availability of external views and natural elements, proximity of staff and communication, aspects of the physical environment, elements of hospitality, preferred furniture and environmental temperature. This review identifies environmental elements that may support person-centred care while on the ED ramp and informs future facility planning.