Hospitals seeing progress on ambulance offload times, but challenges persist

Provincial health authority officials in Nova Scotia believe they've devised a plan that will reduce persistent delays in paramedics being able to transfer patients to emergency departments, but say those efforts will only be successful if changes also occur in other parts of hospitals.

Amid growing reports of ambulances being backed up outside emergency departments and the challenges that creates for paramedics being able to provide coverage in communities, Health Minister Randy Delorey ordered the health authority to come up with a policy to address the issue.

Tim Guest, vice-president of health services for the Nova Scotia Health Authority, said that policy has been signed off on by Delorey's department and is starting to be implemented at five hospitals:

• Dartmouth General
• Halifax Infirmary
• Valley Regional in Kentville
• Colchester East Hants Health Centre in Truro
• Cape Breton Regional in Sydney

The model that's being used in Dartmouth — a transition space where staff are able to receive and wait with patients so paramedics are able to get back on the road — is already seeing results, said Guest, and that approach will also be used in Kentville.

"We're certainly seeing a significant improvement in decreasing the amount of time that ambulances are waiting to offload and we're certainly seeing many fewer days where there's multiple ambulances waiting to offload for hours," he said.

Mike Nickerson, business agent for the union representing paramedics, said the number of code criticals — times when there are no available ambulances in a coverage area — has become less prevalent since Delorey's announcement, although they do still happen.

For more than a year, the union has been running an online campaign to draw attention to code criticals as they happen. Reducing the time paramedics wait with patients in hallways before they can get back on the road makes a significant difference for workers, said Nickerson.

"That is part of the job, but that plays on you mentally when you're standing in a hallway with a patient that you can't offload and you're hearing calls go out and you know that some of these calls are critical and there's no ambulances to respond to them," he said.

Tackling patient-flow challenges

Other efforts to free up space in the targeted emergency departments include using fast-track areas for non-emergency patients who need immediate medical attention for things such as breaks, stitches and sprains. That's a process already being used at the Halifax Infirmary and it will soon expand from 16 hours a day to 24. Guest said job postings are out now to accommodate the additional capacity.

"It will essentially give us an additional 10 or 15 stretchers 24 hours a day, whereas we didn't have access to them for eight hours [each day]. They would have been space that we didn't actually have staffed that we can use."

But Guest said reducing offload delays and other stressors on emergency departments will only be successful if officials can tackle patient-flow issues in other parts of the hospital, including inpatients, where acute-care beds are often tied up by people waiting for other types of care.

The health authority's patient-flow strategy notes most hospitals are at or above 95 per cent capacity and about 50 per cent of inpatients could receive care in other places better suited for their needs.

A call for better technology

While the number of people waiting in hospitals for long-term care spaces has decreased during the life of the current government, the strategy notes there was a 36 per cent increase in the last year. It also points to recruitment challenges for nurses and variability in how doctors practise and the inpatient care they provide as other system pressures.

The strategy calls for a consistent and provincewide approach to managing patient flow, with the ability for decisions to be made 24 hours a day. It recommends a co-ordination centre to oversee that effort and technology that would share information about available space with emergency departments, EHS and other players in the system.

"Current challenges in available technology are significantly impacting the ability to effectively and efficiently flow patients to where they need to be, and as a result causes backlog in the [emergency departments], overcapacity situations in hospitals and results in difficulties offloading patients from ambulances," according to the document.

Another big change called for has to do with how patients are admitted to hospital.

The strategy calls for assigning patients an expected date of discharge when they arrive, which it says would give the patient, their families and care teams the ability to work toward that date and be ready for when it comes, or identify barriers to discharge as the date approaches.

In an interview, Delorey said he and his department would look at proposals as they're submitted, but the minister said the government has shown that it's willing to spend money when the case can be made it will help the system. As evidence, he pointed to the $271-million increase in his department's budget this year.