The Impact of Coordination Between Ambulance Services and Emergency Departments on Healthcare Quality

Abstract

Background. The interface between emergency medical services (EMS) and hospital emergency departments (EDs) is one of the most consequential, yet least governed, transitions in healthcare. Delays in ambulance offload, incomplete handover, absent prehospital notification and uncoordinated diversion compromise timeliness, safety and effectiveness of care, and remove ambulances from community availability.
Objective. To synthesize evidence on how EMS–ED coordination affects healthcare quality across the Institute of Medicine domains; to identify the mechanisms and system determinants of effective coordination; and to propose an implementable framework for practice, policy and research.
Methods. Narrative review informed by the SANRA criteria. PubMed/MEDLINE, CINAHL, Embase, Scopus and grey literature from ambulance and health-system bodies were searched for studies addressing ambulance offload, clinical handover, prehospital notification and activation pathways, ambulance diversion, information integration and joint governance.
Results. Prehospital notification is consistently associated with faster diagnosis and reperfusion in stroke and myocardial infarction. Structured handover tools improve completeness and efficiency of information transfer. Prolonged offload is associated with harm in several large cohorts and removes ambulance capacity from the community, although associations with mortality are modest and not uniform. Ambulance diversion offers little relief of crowding and has been linked to higher mortality in time-sensitive conditions. Root causes lie predominantly in hospital-wide access block rather than in the ED itself.
Conclusions. Coordination between ambulance services and EDs is a modifiable determinant of quality whose benefits depend on whole-system design. The proposed RELAY framework (Real-time information and prenotification, Efficient offload, Language of handover, Aligned system capacity, and Yardsticks with joint governance) offers a structured pathway for health systems, including those undergoing transformation under Saudi Vision 2030.