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Ambulance Offload Delay (AVOD) Escalation

This document provides a summary of best practice in relation to Ambulance Offload Delay (AVOD) Escalation. The summary has been created to support staff during the Sunshine Hospital Emergency Department Redevelopment transition and early post-move period, and has been endorsed by the ED Leadership Team.  



Ambulance Offload Delays (AVODs) occur when the care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency department (ED). Typically, AVODs are caused by emergency department crowding, acuity, or lack of inpatient bed capacity. AVOD escalation aims to reduce Ambulance Victoria’s (AV) wait times and improve offload performance against the DHS performance targets (90% of all patients who arrive via ambulance offloaded within 40 minutes).


This QRG applies to staff working in all WH Emergency Departments as well as other stakeholders identified in the huddle framework.


It is the responsibility of the Nurse Unit Managers, Directors of the Emergency Departments of each site, Operations Managers of Emergency Services and of Access, and Hospital Ambulance Liaison Officers (HALO), to ensure the relevant staff are familiar with this QRG, that it is implemented according to the guidelines as outlined within, and that there is compliance by all staff members.

Process Details

The guiding principles for resolving or avoiding AV Offload delays involve mobilising the Emergency Department and wider hospital teams where required in order to create space to facilitate offload.  This means ensuring an appropriate location, with the right resources available for the patient is found or created, to allow patients arriving via Ambulance to be offload in under 40 minutes. It is important to note, the 40-minute offload time starts from the AV Arrival Time (which can be from the time AV are reversing into the AV bay) and not the triage time.  The 40 minutes ceases at the agreed Ambulance Handover Time as documented in FirstNet.

It should be noted at all stages of escalation, documentation of the plan should be entered in FirstNet.

How to document AV offload delay in FirstNet.

FirstNet-Ambulance-Handover_Offload.pdf (

The agreed principles include:

  1. Western Health will ensure the ED is a safe place for patients and staff.
  2. No CAT 1 (BAT calls) diversions
  3. To offload AV to release back to community

Before contacting AV and requesting a redistribution, all reasonable strategies as outlined by this QRG will be implemented by Western Health and are without resolution or require a significant amount of time to create further capacity.


Supporting Documents

Appendix 1 - ED Escalation Process for Ambulance Offload Delays Flowchart

Appendix 2 - ED Ambulance Offload Delays Huddle Checklist

Escalation to Ambulance Victoria

Document Governance

Title: Ambulance Offfload Delay (AVOD) Escalation
Version: 4
Date Published: October 2022
Date of scheduled review: October 2023
Author:  Approver: 
ED Leadership Team ED Leadership Team
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