Waterloo region paramedics to implement Fit 2 Sit this fall in order to speed up transfer times

The Region of Waterloo Paramedic Service plans to implement a new Fit 2 Sit program this fall that will speed up the process of transferring patients to hospital if those patients can safely wait for care in a hospital's waiting room.

The initiative is part of a series of efforts aimed at reducing the amount of time paramedics are delayed at the Grand River, St. Mary's General and Cambridge Memorial hospitals and increasing the availability of ambulances in the community, said John Riches, the chief of the region's paramedic service.

Paramedic services across the province have been struggling to respond to ballooning call volumes, an increase in the severity of patients' conditions and longer offload times at hospitals, according to a 2020 CUPE report — all of which have contributed to what the Region of Waterloo service calls "code reds," periods of time when there are no ambulances available to respond to calls. 

While the number of code reds dropped to 38 in the first half of 2023 from 59 during the same period last year, the number of hours spent in code red actually climbed to nearly 17 from just over 15. 

"The number of times that code reds or code yellows occur is still deeply concerning," Riches said, despite the drop in the number of incidents.  

"Nobody wants there to be no paramedics available to respond to calls in the community. Nobody wants that situation."

Paramedics already transfer some patients from ambulances into hospital waiting rooms, Riches said. 

Fit 2 Sit will establish a formal process for doing so, which will cut down the time involved, he added.

It will also clearly spell out the criteria for who can and cannot be left unattended to wait for care.

Fit 2 Sit programs commonly require patients to be alert and able to sit or stand, and to have vital signs in normal ranges. They exclude patients whose conditions rank high on the Canadian Triage Acuity Scale (CTAS).

The paramedic service plans to monitor the time it spends transferring patients to hospital waiting rooms before and after it implements Fit 2 Sit to assess how well the program works, Riches said. 

It will also look at patient outcomes.

Fit 2 Sit only part of the solution 

"Us and our hospital partners are committed to changing the program if we need to," Riches said. 

"Maybe that change might be broadening who's eligible for Fit 2 Sit, or it might be narrowing it, depending on, you know, what the metrics are telling us."

The paramedic service is also looking at other options to improve ambulance availability, Riches said. 

It would like to see an alternative destination clinic designated in the community so that paramedics can take those suffering mental health and addictions-related issues somewhere other than a hospital.

Riches said he also hopes that changes to the province's call priority algorithms will make it easier to separate true emergencies from situations where patients can wait longer for assistance. 

The Guelph Wellington Paramedic Service implemented Fit 2 Sit in 2019 with Guelph General Hospital said Leanne Swantko, the service's deputy chief.

Program a success even if numbers don't show it

It rolled it out to three other area hospitals last year.

Swantko said the program has been a success.

"It doesn't have a big dent in the overall code red and offload scenarios," she said of Fit 2 Sit. 

"But when we're looking at one patient at a time, some nights, you know, one ambulance is available, and that's all we have. It does make a significant difference for a community that we're able to implement the Fit 2 Sit program."

Even with the program in place, the paramedic service failed to meet a single 2022 response time target in its response time performance plan, mandated by the Ontario Ministry of Health.

Swantko blames that on an array of factors including higher call volumes, sicker patients, and staffing shortages at the hospital, which were exacerbated by the COVID-19 pandemic. 

So far, just under 500 patients have been transferred to hospital waiting rooms under Guelph's Fit 2 Sit program. 

Of those, five subsequently saw their conditions deteriorate, Swantko said. 

'It's working fantastic'

The Sault Ste-Marie paramedic service has posted similar statistics since implementing Fit 2 Sit with the Sault Area Hospital in April of last year.

Paramedics have diverted around 475 patients to the hospital's triage area, according to Dan Langevin, the deputy chief of the paramedic service.

Less than five subsequently saw their conditions deteriorate. 

"I think it's working fantastic," Langevin said.

"Paramedics have been doing this for a long time. It just wasn't an official program … They would go up to the charge nurse and say, 'You know what? This patient really doesn't need the emerge right now. They could go and sit in the waiting room.' And so they would make a collaborative decision on that. And so that takes time too, because that nurse is busy doing other things. So having the established inclusion and exclusion criteria … there is no discussion. There's no, you know, time wasted that way." 

Fit 2 Sit was part of a series of initiatives the paramedic service implemented to bring down their offload wait times at the hospital, said paramedic chief, Kate Kirkham.

Others included working with the hospital to ensure there is always a nurse or paramedic dedicated to offloading patients at the facility; having one team of paramedics care for up to four patients in the hospital cue; diverting patients with addiction-related issues to detox, and increasing the use of a private company for non-urgent patient transfers such as transfers to routine appointments. 

The number of code reds dropped from 227 in 2021 to 170 in 2022 to just 15 in the first quarter of 2023, according to data supplied by Kirkham. 

The number of times that an urgent call has been delayed as a result,has dropped from 51 and 54 in 2021 and 2022 respectively to nine in the first quarter of 2023.