Waiting at the Hospital
- Thread starter CANDawg
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We rarely have any delays here. Pull in the ambulance bay, unload pt, go to assigned bed or station where an rn is usually waiting for usgive report, clean up and go available. Whole process is usually 10 to 25 min. We have paper pcrs that have to be completed before we return to service.
JPINFV
Gadfly
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Depends on the hospital, depends on the patient.
Shishkabob
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Hardly ever have any issues, and on the days we do, it's when EVERY hospital is busy as heck and we are busy as heck, compounding eachothers issues.
The hospitals know they have about 20 minutes. If they exceed that, things get handled. If it gets bad, we have the ability to have a supervisor come out and they take over patient care while we grab a new stretcher and go back out (I've never had to). It got so bad at one hospital that we stated we'd start to divert to other hospitals if they didn't fix it, they called us on it, we quit going and pretty darn quick their board had a change of heart. No issues since.
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For me, a non-emergency transfer means that I'm going direct to a floor, and an assigned bed. I have never had any delays with those transfers. An "emergency" transfer means that I'm going to the ED, regardless of the mode of travel (Code 2 or 3). In the event that I'm going from one facility to an ED at another facility, I would expect that arrangements have already been made. I have rarely had any delays with those kinds of transfers. Occasionally I've done responses to a SNF where the destination hasn't been set up, and I've had to get a hospital status, and make the decision then, as if it was a regular scene call. Those and any other typical scene call are the only ones where I've ever encountered any sort of a delay. Generally, the delays have been short and I've never EVER dumped the patient and ran as the receiving hospital has usually figured out where the patient needs to be. Sometimes that's in triage... On occasion I have suggested that the patient probably should be put in the triage area... and I've never had any complaint about those times that I do. It's usually pretty obvious...
Wow. Here it is a huge problem. While it has gotten better, the AVERAGE wait time relatively recently was close to 2 hours. (Source: http://www.sherwoodparknews.com/ArticleDisplay.aspx?e=3458948) Its something that the government has said they are 'working on', and white other programs have been put in place to help they are really only a stopgap solution. One program is dedicating an EMS team to the hospital their entire shift accept transfers from rig crews and until hospital staff get around to transferring them in. Honestly, it makes me a little hesitant to work for the provincial 911 system.
I was curious to see if this was a common problem, or just us. :wacko:
I was curious to see if this was a common problem, or just us. :wacko:
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the_negro_puppy
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Oh lawd...I wish we had a 20 minute limit here.
Delays in offloading patients has hit crisis point. More often than not we are waiting 30 + minutes, my longest personal is 4 hours.'
Its so bad they have had to initiate studies, reports and research to try and fix the problem. The main issue is bed access block. Patients being stuck in the EDs due to no ward beds.
For my state service alone in 2010/2011 there was 1,315 DAYS of lost time by Paramedics waiting for > 30 minutes to offload. When it gets bad we are told to put our patients back in the ambulance and wait on the ambulance know as "ramping". Its a terrible waste of resources and we often spend half our shifts at hospital.
Delays in offloading patients has hit crisis point. More often than not we are waiting 30 + minutes, my longest personal is 4 hours.'
Its so bad they have had to initiate studies, reports and research to try and fix the problem. The main issue is bed access block. Patients being stuck in the EDs due to no ward beds.
For my state service alone in 2010/2011 there was 1,315 DAYS of lost time by Paramedics waiting for > 30 minutes to offload. When it gets bad we are told to put our patients back in the ambulance and wait on the ambulance know as "ramping". Its a terrible waste of resources and we often spend half our shifts at hospital.
DrParasite
The fire extinguisher is not just for show
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for a 911 call, our units are expected to be available for the next job in under 10 minutes. if it's busy, they get 20.
at my old job, once you arrived at the ER, you were put available for the next job. if you get a job, than the crew was delaying the job, even if the delay was due to turnover from the previous assignment. This was management's decision, and decree, not mine, so please don't ask me why because I sure as heck didn't agree with it.
for a non-emergency transport (interfacility or nursing home, or any other prescheduled transport), if you aren't going to a floor, and are dropping off in the ER, the wait time is usually less than 30 minutes or less. sometime you are out the door in 10, but usually 30 only if they are really busy.
My personal opinions about absurd wait times (anything in excess of 20 minutes for a 911 ambulance, hour+ waits are asinine and are a sign that the ER needs more staff or is being mismanaged) have been posted in other threads.
at my old job, once you arrived at the ER, you were put available for the next job. if you get a job, than the crew was delaying the job, even if the delay was due to turnover from the previous assignment. This was management's decision, and decree, not mine, so please don't ask me why because I sure as heck didn't agree with it.
for a non-emergency transport (interfacility or nursing home, or any other prescheduled transport), if you aren't going to a floor, and are dropping off in the ER, the wait time is usually less than 30 minutes or less. sometime you are out the door in 10, but usually 30 only if they are really busy.
My personal opinions about absurd wait times (anything in excess of 20 minutes for a 911 ambulance, hour+ waits are asinine and are a sign that the ER needs more staff or is being mismanaged) have been posted in other threads.
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From personal experience, many places, especially in my neck of the woods in PA, you get a bed almost immediately. If the ED's slammed, and you patient is relatively stable, you might wait for a bit. 15 minutes is about as long as I've waited.
I also see other systems where EMS is expected to hold the wall for 5, 10, 15 minutes in a NOT busy ED because the RN is too lazy to multitask. These places get even worse when the ED's busy.
Systems where it's a recurring problem often have procedures in place to reduce the impact. For example, I know of systems that send a supervisor out and put the ED on Bypass when they have X-many crews sitting there waiting to transfer care.
I also see other systems where EMS is expected to hold the wall for 5, 10, 15 minutes in a NOT busy ED because the RN is too lazy to multitask. These places get even worse when the ED's busy.
Systems where it's a recurring problem often have procedures in place to reduce the impact. For example, I know of systems that send a supervisor out and put the ED on Bypass when they have X-many crews sitting there waiting to transfer care.
DesertMedic66
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Usually as we are walking into the ER we have a bed number and a nurse at the bedside.
The longest I have been on "bed delay" is maybe 20 minutes.
The longest I have been on "bed delay" is maybe 20 minutes.
Don't come to riverside then lol
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As said, direct admits are usually pretty quick though one hospital network requires patients being admitted to go through the ED and be "seen" by a doc, who just looks at vitals and history. Sometimes it takes a bit for the doc to come by.
Going to most EDs the wait is usually only in triage if there are other crews in front of us. Even if the ED and hospital is slammed they'll find a bed and put it in the hallway, they've become quite good at finding room since the state mandated that diversions can only occur during an internal disaster. And for what it's worth around here, we get triaged first come first served so long as nothing serious comes in behind us. Out of area IFT companies do not get passed over by city crews as happens in some other places apparently.
Going to most EDs the wait is usually only in triage if there are other crews in front of us. Even if the ED and hospital is slammed they'll find a bed and put it in the hallway, they've become quite good at finding room since the state mandated that diversions can only occur during an internal disaster. And for what it's worth around here, we get triaged first come first served so long as nothing serious comes in behind us. Out of area IFT companies do not get passed over by city crews as happens in some other places apparently.
DesertMedic66
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Bullets
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Usually 5-10 minutes transfer care to the triage nurse
DrParasite
The fire extinguisher is not just for show
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If this is directed at my statement about 911 crews priority over IFTs, I would like to respond.
If your triage based on a first come/first serve basis, than they are doing it wrong. Triage should go on a sickest first, regardless of order of arrival. IFT vs City 911 doesn't matter, if an IFT brings in a sick person, they get seen before a City 911 units. But if everyone is equally sick (or not sick), than they wait in line of order of arrival.
The reason 911 has shorter turnaround times is because 911 units are answering emergency calls (which are in theory emergencies, at least according to the callers), while the IFT companies are handling prescheduled transports or emergencies that have already been evaluated by a nurse and/or doctor, and those health care professionals have determined that a 911 response is not warranted due to the patient's condition. Again, this is all in theory, and as I have been educated by others on here, there are quite a few nursing homes and SNFs that do their patient's a disservice by not calling 911 and force the patients to wait for an IFT unit which can be coming from 20 miles away or have an extended ETA.
I loved bringing in a 3rd degree heart block, and having this conversation:
Nurse: " its gonna be a while, were on diversion."
Us: " uh, you weren't when we called. "
Nurse: "*walks over to the station and picks up the phone* yeah, we are now."
Us: "He's infarcting as we speak...."
Nurse: "well, should have picked another hospital."
ER Doc: "jesus Christ! What is he still doing in the hallway?!?"
Instantly got a bed.
Nurse: " its gonna be a while, were on diversion."
Us: " uh, you weren't when we called. "
Nurse: "*walks over to the station and picks up the phone* yeah, we are now."
Us: "He's infarcting as we speak...."
Nurse: "well, should have picked another hospital."
ER Doc: "jesus Christ! What is he still doing in the hallway?!?"
Instantly got a bed.
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The first part is identical to what happens, "stable" patients get seen in order of arrival by the triage nurse. In some places that isn't the case, and "stable" patients brought in by city crews used to be able to cut the line, it used to happen in Boston apparently quite a bit. Not sure what you mean by turnaround times, I'm in out of the ED as quick as any other crew, sometimes faster if there is already a bed waiting because the sending facility called ahead (common out in the suburbs).
As for SNFs doing a disservice by calling a private company, that just isn't the case a lot of the time. For starters many municipalities frown on large facilities calling 911 for every EMS call, that would be a complete sink of resources. Plus where I work, a nursing home calling us instead of 911 is going to get an ALS unit if available, while the city will usually only send BLS unless it is something obviously serious (arrests, seizures, etc). We can also transported vented patients on a vent, the city cannot. Finally, if our ETA is excessive, we just call the AHJ's EMS and give them the call. Sure there are companies with more shady policies, but that's not always the case.
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We Triage pts on our call in using the Canadian Triage And Acuity Scale (CTAS)
(same standards and guidelines the hospitals use) Our bed/unit assignment is based off of our CTAS score.
CTAS Level 1 - Resuscitation Conditions that are threats to life or limb (or imminent risk of deterioration) requiring immediate aggressive interventions. Examples of types of conditions that would be Level 1are: Cardiac/Respiratory arrest, major trauma, shock states, unconscious patients, severe respiratory distress.
CTAS Level 2 - Emergent Conditions that are a potential threat to life limb or function, requiring rapid medical intervention or delegated acts. Examples of types of conditions which would be Level 2 are altered mental states, head injury, severe trauma, neonates, MI, overdose and CVA
CTAS Level 3 - Urgent Conditions that could potentially progress to a serious problem requiring emergency intervention. May be associated with significant discomfort or affecting ability to function at work or activities of daily living.
Examples of types of conditions which would be Level 3 are moderate trauma, asthma, GI bleed, vaginal bleeding and pregnancy, acute psychosis and/or suicidal thoughts and acute pain.
CTAS Level 4 - Less Urgent (Semi urgent)
Conditions that are related to patient age, distress, or potential for deterioration or complications would benefit from intervention or reassurance within 1-2 hours). Examples of types of conditions which would be Level 4 are headache, corneal foreign body and chronic back pain.
CTAS Level 5 - Non Urgent Conditions that may be acute but non-urgent as well as conditions which may be part of a chronic problem with or without evidence of deterioration. The investigation or interventions for some of these illnesses or injuries could be delayed or even referred to other areas of the hospital or health care system. Examples of types of conditions which would be Level 5 are sore throat, URI, mild abdominal pain which
is chronic or recurring, with normal vital signs, vomiting alone and diarrhea alone.
http://caep.ca/resources/ctas
(same standards and guidelines the hospitals use) Our bed/unit assignment is based off of our CTAS score.
CTAS Level 1 - Resuscitation Conditions that are threats to life or limb (or imminent risk of deterioration) requiring immediate aggressive interventions. Examples of types of conditions that would be Level 1are: Cardiac/Respiratory arrest, major trauma, shock states, unconscious patients, severe respiratory distress.
CTAS Level 2 - Emergent Conditions that are a potential threat to life limb or function, requiring rapid medical intervention or delegated acts. Examples of types of conditions which would be Level 2 are altered mental states, head injury, severe trauma, neonates, MI, overdose and CVA
CTAS Level 3 - Urgent Conditions that could potentially progress to a serious problem requiring emergency intervention. May be associated with significant discomfort or affecting ability to function at work or activities of daily living.
Examples of types of conditions which would be Level 3 are moderate trauma, asthma, GI bleed, vaginal bleeding and pregnancy, acute psychosis and/or suicidal thoughts and acute pain.
CTAS Level 4 - Less Urgent (Semi urgent)
Conditions that are related to patient age, distress, or potential for deterioration or complications would benefit from intervention or reassurance within 1-2 hours). Examples of types of conditions which would be Level 4 are headache, corneal foreign body and chronic back pain.
CTAS Level 5 - Non Urgent Conditions that may be acute but non-urgent as well as conditions which may be part of a chronic problem with or without evidence of deterioration. The investigation or interventions for some of these illnesses or injuries could be delayed or even referred to other areas of the hospital or health care system. Examples of types of conditions which would be Level 5 are sore throat, URI, mild abdominal pain which
is chronic or recurring, with normal vital signs, vomiting alone and diarrhea alone.
http://caep.ca/resources/ctas
Underoath87
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Between 15 minutes and 3 hours. Usually about 45 minutes. It mostly just depends on how busy the ER is.
Amen to that.
Most of our triage nurses have no concept of what it truly means to do triage. "Take a number and wait your turn" is their motto. They almost never see beyond the person right in front of them. We usually do self triage; if someone rolls in who looks sick, either the crew asks if they can jump or we offer up if I notice. I sometimes think a full scale riot could be taking place under their noses and they wouldn't notice.
As for the wait times, if our patient is off the gurney in less than 45 minutes, we think we're doing pretty good. 1-2 hours is the norm. Of course, if the EMS triage nurse wasn't also the charge nurse (for a ~120 bed ED, level I trauma center), and the backup nurse for the trauma bay (a 7 bed critical care area for the ED, not just trauma) and also backing up ambulatory triage, and taking patients to the floors, and distributing meals, and just generally getting lost for 30+ minutes at a time, our drop times would probably be better.
2 cases that I actually witnessed:
BLS crew brings in a stable patient. They're busy, but not horrendous. Triage nurse actually snaps at the crew, in front of the patient: "We're busy, and you shouldn't have come here. You need to take him to a different facility." I actually stepped in and advised her of their EMTALA obligation, and she called the nurse manager, crying that I was picking on her. Nurse manager came out and told her she was wrong, relieved her, and triaged them and got them a bed.
Watched a helicopter crew come in with an ATV accident with a patient in a traction splint (obvious mid-shaft femur fx) and a R/O surgical belly. They got sent to triage and waited nearly an hour, because the facility was "short staffed".
I hate they way our hospital administrators think EMS falls on the ladder (bottom broken step) and breeds the same feelings in their staff.