DDHA 9500 Week 2 Problem Statement Example

Problem Statement: Ambulance Crews Held at the Emergency Department Door at a Three-Hospital System, With a Sentence-by-Sentence Account of How It Was Built

Student Name

Walden University

DDHA 9500: DHA Project Prospectus

Instructor Name

Month Day, Year

Problem Statement: Ambulance Crews Held at the Emergency Department Door at a Three-Hospital System, With a Sentence-by-Sentence Account of How It Was Built

Problem Statement

At the three emergency departments of a regional health system, ambulance crews routinely wait beyond the 30-minute interval within which emergency medical services standards expect hospital staff to accept care of an arriving patient, and the system has no measure that links these waits to conditions inside its hospitals. The consequences fall first on the county's residents, who wait longer for an ambulance while crews are held at a hospital, and then on the patients on the stretchers, whose care is delayed in a corridor. Offload delay is not confined to one setting: a statewide analysis of California's local emergency medical services agencies found wide variation in how long crews waited to hand over patients (Feldmeier et al., 2024), and a review of the international literature found most studies tying delays to what happens inside hospitals once their beds are full (Li et al., 2019). Despite this, the system's operational reports measure emergency department length of stay and boarding but not offload time, and its hospitals and the county ambulance service each hold half of the time stamps needed to measure it. This project addresses the association between inpatient boarding in the emergency department and ambulance offload time at these three hospitals; it does not address the county's ambulance staffing, response times or dispatch.

How Each Sentence Was Built

The first sentence names the gap in operational terms. It describes what is going wrong, crews waiting beyond a recognized interval with no measure connecting the wait to hospital conditions, rather than what the writer would like installed, such as an offload nurse program. A statement framed as the absence of a solution assumes its conclusion. The 30-minute reference reflects the interval commonly used in emergency medical services guidance; the national position statement resource document by Cooney et al. (2011) describes offload delay as a hospital responsibility once the patient arrives.

The second sentence names who carries the consequences, in order of reach. Residents waiting for an ambulance are affected even though they never enter the hospital, which is why the problem matters beyond the emergency department.

The third and fourth sentences carry the evidence, each attributed. One source is regional and recent, the California analysis, and one is a review spanning many settings. Together they show that the gap reaches past one building without claiming a national figure that does not exist; no national dataset reports offload times for every hospital. The fourth sentence adds the local fact that makes the gap researchable and also explains why it persists: the data are split between two organizations.

The final sentence draws the boundary. The project concerns the hospital side, boarding and offload, and explicitly sets aside ambulance staffing, response times and dispatch, which are the county's responsibility and a different study.

What the Statement Leaves for Later

The statement does not name a method, a sample size or a hypothesis. Those belong to the purpose statement and the approach outline in later weeks. Keeping them out of the problem statement prevents the problem from being described in a way that only one method could address.

References

Cooney, D. R., Millin, M. G., Carter, A., Lawner, B. J., Nable, J. V., & Wallus, H. J. (2011). Ambulance diversion and emergency department offload delay: Resource document for the National Association of EMS Physicians position statement. Prehospital Emergency Care, 15(4), 555-561. https://doi.org/10.3109/10903127.2011.608871

Feldmeier, M., Reyes, K. P., Chen, C., Sporer, K. A., Konik, Z., Garzón, H., & Hsia, R. Y. (2024). Patterns in California ambulance patient offload times by local emergency medical services agency. JAMA Network Open, 7(12), Article e2451022. https://doi.org/10.1001/jamanetworkopen.2024.51022

Li, M., Vanberkel, P., & Carter, A. J. E. (2019). A review on ambulance offload delay literature. Health Care Management Science, 22(4), 658-675. https://doi.org/10.1007/s10729-018-9450-x