Initiatives to reduce ambulance offload delays in emergency departments: a scoping review

Emergency departments (EDs) globally are experiencing increased pressure from crowding and ambulance offload delays (AODs), exacerbated by high hospital occupancy rates and insufficient bed capacity. Despite the significance of AODs, limited research exists on interventions to target such delays. This scoping review aims to identify evidence-based interventions to mitigate AODs and seeks to pinpoint gaps in existing literature, with a particular focus on the effectiveness of ED-based initiatives. Guided by the Joanna Briggs Institute methodology for scoping reviews, a systematic search was conducted across MEDLINE, AMED, Embase Classic+, Emcare, and CINAHL including articles to April 2025. All articles were screened in Covidence©. The inclusion criteria focused on initiatives within the ED setting, excluding studies on ambulance diversion, infrastructure changes and effective handover. Sixteen articles were identified with interventions spanning the ED input, throughput, output concept. Some strategies showed potential in reducing both AODs and ED crowding, while others demonstrated effectiveness in only one of these outcomes. Ambulance offload zones were shown to reduce AODs, four-hour key performance standards reduced ED crowding, and early clinician assessment reduced both AODs and ED crowding. By mapping existing interventions and highlighting knowledge gaps, this scoping review provides a comprehensive overview of strategies to mitigate AODs. Front-loading patient care through multi-interventional methods can reduce AODs. The identified interventions hold promise, however, ongoing innovation, evaluation and exploration of system-wide approaches and advancements in healthcare technology are necessary to enhance ED efficiency. Future research should prioritise systemwide initiatives and the potential of emerging technologies to offer scalable solutions for AODs.