Patient offload delays soar
Niagara paramedics spent 15,438 hours waiting outside emergency departments last year.
That’s the accumulative equivalent of about one year and nine months, and nearly 10,000 hours longer than ambulances spent waiting to deliver patients to emergency departments in 2016.
It’s also more than 5,000 hours longer than the previous record set in 2010, when initiatives were put in place to reduce offload delays among Niagara Emergency Medical Services paramedics.
A report on the huge increase in ambulance offload delays is being presented at Niagara Region’s public health committee meeting next month. The report blames the problem on a lack of hospital emergency department beds, a lack of hospital beds for patients admitted through emergency departments, and a lack of alternative care beds in the community.
The Niagara EMS report says not addressing the problem “would put the lives and health of Niagara residents at risk.”
Niagara Health chief nursing executive Derek McNally said hospital management and physicians and Niagara EMS representatives have worked together to develop a “tactical plan” which includes several initiatives to reduce the hours of offload delays, while also providing “timely access to care and services in the hospitals.”
“We’ve identified a seven-point plan which is going forward to both of our senior teams for approval,” he said. “We’re hopeful that these strategies will continue to help us manage those offload hours and reduce them.”
The initiatives, which include streamlining information sharing between paramedics and emergency departments plus improved management of the flow of patients arriving at the hospital, are to be fully implemented by March 5.
Niagara EMS is also working towards other unique solutions, such as transporting low acuity patients to urgent care centres in Port Colborne and Fort Erie, rather than to emergency departments.
Patients, too, can help alleviate the situation, by opting to go to urgent care centres, walk-in clinics or doctors offices rather than emergency departments.
McNally said the “know your options campaign” advises patients on the most appropriate medical facilities for their condition. More information on that campaign is available online at niagarahealth.on.ca/site/know-your-healthcareoptions-in-niagara.
“We continuously use social media to make sure we get that out,” McNally said.
It’s not the first time Niagara’s paramedics have dealt with excessive offload delays. When delays reached their previous peak in 2010, initiatives implemented at local hospitals managed to reduce the hours of waiting by 77 per cent in the following four years, to a low of about 2,107 in 2014 — despite annual increases in call volume.
But the hours of offload delays have since rebounded, reaching their peak last year.
“I think the landscape was different then than it is now,” McNally said.
We’ve identified a seven-point plan which is going forward to both of our senior teams for approval. We’re hopeful that these strategies will continue to help us manage those offload hours and reduce them.”
Derek McNally, Niagara Health chief nursing executive
And this time, he said, one of the biggest issues emergency departments are facing is the gridlock that occurs when patients who are being admitted to hospital remain in emergency departments, using stretchers that would otherwise be used for incoming patients.
Efforts have been made to address that problem, too, with additional Ministry of Health funding to pay for 26 new “flex beds.”
The 26 beds, all in Welland, are being used for alternative level of care (ALC) patients, who don’t necessarily require an acute care hospital but have nowhere else to turn while awaiting communitybased services they need.
By freeing up acute care beds for incoming patients, McNally said, the ALC beds help alleviate pressures on other hospital services such as emergency departments.
The offload delays are hitting the Region financially, too.
The report says the delays last year cost Niagara $1.59 million, and that doesn’t include overtime, missed meal breaks, increased illness, additional supervisor support and additional staffing. In addition, the provincial government provides Niagara EMS with $817,000 in funding for additional nursing staff who assume temporary care of patients who are awaiting on offload delay.
McNally said similar problems are happening at hospitals across the province. Hamilton paramedics, for instance, spent 26,000 hours waiting to deliver patients last year.
It has also led to numerous “code zero” problems, when there are no ambulances available to respond to emergencies.
Despite the huge increase in delays in Niagara, Niagara EMS community engagement and awareness officer Mayram Traub said local paramedics have managed to avoid that scenario.
“Our last code zero we had was in 2014, and that lasted less than four minutes,” Traub said.
The report attributes Niagara’s ability to keep ambulances rolling to operating its own ambulance dispatch centre, giving it the ability to better prioritize the calls it receives.
“I think that is credit to how we do business differently here in Niagara,” Traub said.