Hospital offload delays jump 57% in WaterlooWellington

Bottlenecks continue to put strain on paramedic services in region; delays come amidst rising demand

HOSPITALS CONTINUED TO BE a major bottleneck for ambulances in the Waterloo Region, according to a new report by region’s public health and emergency services department. Between January and August of this year, offload delays – the amount of time spent by paramedics waiting to turnover their patients at the hospital – rose another 57 per cent in the Waterloo-Wellington area.

The delays put a major strain on the region’s already tightly stretched emergency services, which have only just kept up with rising demand in the region.

“That’s a continuing issue. Actually, last year we had a 102 per cent increase [in offload delays]. So this is just a continuous rise in offload delay within the system,” said Stephen Van Valkenburg, chief of paramedic services for the region.

On average, the region’s ambulances lost a combined 22 days per month waiting at the hospital to offload their patients. That was up from 14 days in 2017 over the same period. Put another way, almost a month-worth of ambulance services was spent delayed at the hospital.

“We’re really sort of at the mercy at the hospitals - if they can’t accept a patient, we can’t just dump the patient and walk away. We have to stay with them in the hallway until they can actually take over the patient,” Van Valkenburg explains.

The hospitals in turn are at the mercy of the prevailing health demands of Ontario residents, as well as the management practices of the province.

“The increase in offload delays is due to an increase in surge rates at our local hospitals. This surge in EMS (emergency medical service) has been seen across Ontario and is putting pressure on many Paramedic Services,” said a spokesperson for the Waterloo-Wellington Local Health Integrated Network (LHIN). The WaterlooWellington LHIN operates hospitals in the area under the direction of the provincial government.

“There are numerous factors causing this, including an aging population, increasing complexity of health issues in the community, and individual’s choice to call 911 and request Paramedic transport to hospital.”

The region did see a slight improvement this year in paramedics response time, which increased on average ten seconds for the region. However, the improvement is not nearly commensurate with the number of ambulances that have been added to the region’s fleet in recent years. In February of this year, two new 12hour ambulances were put into service. Another three ambulances were added to the region’s fleet in July of last year and two more the year before that.

“It’s a bit of a vicious circle for us, that we add resources on when [regional] council approves resources, and we certainly don’t want them caught up in the vortex of offload delay. We have modified our deployment plan, and we’ve really done as much as we can to try and create efficiency within the system,” said Van Valkenburg.

While ambulances and hospitals have similar roles in healthcare, the two are managed under by different levels of government. The region handles the responsibility for emergency services and ambulances while the province operates the hospitals through the Local Health Integration Network (LHIN).

“We do have the offload nurse program which is in effect, but that’s a band-aid solution for a much bigger system issue,” he says. “So we look to the government and the hospitals to figure out what they’re going to do on this... We’ve become caught up in the offload delay situation because of the systemic issues in the hospital.”

The province has pledged to end “hallway medicine” and curb delays in offloading patients at hospitals, which Van Valkenburg says have been affecting municipalities throughout the province.

“There has been some advocacy on behalf of regional council towards the ministry, to increase the offload funding to our hospitals, and I’m sure there’s going to be some more advocacy with the result of the report,” said Van Valkenburg.

“But this is not just a regional issue here –it’s across the province, it’s across Canada. It’s a big issue, and as bad as our situation seems, there’s other municipalities that are five-times what we are. So it’s a huge healthcare issue.”