EMS Offload in ER

[emtnerd]

Doing a research paper on the efficacy of EMS offloading areas in ERs to improve wait times. Having a hard time finding good research on the topic. Help please!!

[Amhet1]

It is unclear what it is you are asking. Depending on what it is, I have 3 different responses. The easiest thing to do would be to give us a working thesis statement and we can build from there.

By offloading area, are you talking about the design of the parking area/drop off for the ambulance and patient or (my personal guess) somewhere to take the patient within the ER to pass report and drop the patient (Sort of a triage/holding area)?

I have seen some discussions on Google/NEMSMA about extended times at ERs because they couldnt transfer care to the ER staff. There were some times discussed where drop off would range from 30 minutes (quick) to an excess of over 2 hours!

Because of those kind of drop times, members of the group came up with 3 options.

An EMS/Fire service actually put a paramedic in the ER to accept the patients and get the rig back in service. This was tried for 2 months and the service found a dramatic decrease in drop times. This program was dropped because the ER started thinking that the PM was theirs to do with what they wanted. It ended up creating more animosity than it was worth.

Another area found their drop times so bad that they went to the medical control board and had all of the hospital CEOs sign off that any times greater than 30 minutes waiting to hand off a patient to get the rig back in service would be billed to the hospital. They all agreed to it but I doubt the service ever got any money out of the hospital.

The 3rd option, again approved by the hospitals, was that the ranking supervisor would had the option to call the CEO AT HOME when drop times were excessive. You would see how motivated the ER would become when the CEO is screaming over the phone at the shift supervisor of the ER.

Not on topic, but an interesting side note.... There are some hospitals out there that have a habit of going on divert. In some of those cities, when one hospital goes on ER divert, they other hospitals do the same so they wont get an overload. Many services have made it clear that if more than 2 hospitals in the same city are on divert, the divert is null and void. This is frequently the call of the Comm Center. If you would a bit more on this and EMTALA, take a look at http://www.pwwemslaw.com/content.aspx?id=234

Keep us informed what direction you want to head it, Im sure you will find plenty of help from some of us "old guys".

[ConstanceGoodheart]

Not on topic, but an interesting side note.... There are some hospitals out there that have a habit of going on divert. In some of those cities, when one hospital goes on ER divert, they other hospitals do the same so they wont get an overload. Many services have made it clear that if more than 2 hospitals in the same city are on divert, the divert is null and void.

That has pretty much happened by me...EVERY hospital in my transport zone and just beyond were on divert (well except the county psych hospital but who cares about them)...

But anyway, I took my patient into the one ER (that led off on the divert alerts) and a nurse pretty much bitched me out. I pulled out my cell phone that had all the alerts for every hospital still in the message history and I told her that "since EVERYONE was on divert, to me that means YOU ALL are accepting patients, or are you refusing my patient and expecting me to transport the to --hmm-- Trenton? I can do that! Then I'll take a side trip up to DOH & OEMS and file a few complaints." I got a bed for my patient with an attitude from the nurse. Don't know her name, but I can pick her out of a line up.

[Amhet1]

Theres an easy one-word answer to her.....

EMTALA

:shock:

[emtnerd]

Myself and a small group of other EMT's and Medics work in the ER at two Edmonton hospitals. We are responsible for 3 patients and have our own patient care area within the emerg department. I am looking for information on whether or not this sort of program has been successful in the past with reducing crew wait times.

[Amhet1]

I really cant comment much on your situation, but your quality guru should be able to pull up numbers from prior to ya'll being in the ER to now. If your crews are able to drop the patient directly on ya'll in the ER, there should be a significant differernce in drop times.

If ya want to impress him (or look like a complete fool) ask him/her for a control chart showing drop times from prior to ya'll being in the ER to now. He should have that at his fingertips.

You should have enough resources available to find similar information either on the web, or more likely, a few calls to the provincial EMS bigwigs.

I know ya'll are lightyears ahead of us in training requirements, tho it sounds like protocols are similar. I was wondering if ya'll are watching the progress on our NEMSIS project? http://www.nemsis.org/ We are FINALLY getting a national standardized dataset for charting/quality/reporting. We have a long way to go to improving our EMS system, but this will be a good start for us. Once we have that operationalized, we can start getting standardized quality definitions! Right now we have each manager defining his own data such as when the clock starts and stops on responses.

Wow, I only went off-topic once (I think)

[Don1977]

That has pretty much happened by me...EVERY hospital in my transport zone and just beyond were on divert (well except the county psych hospital but who cares about them)...

But anyway, I took my patient into the one ER (that led off on the divert alerts) and a nurse pretty much bitched me out. I pulled out my cell phone that had all the alerts for every hospital still in the message history and I told her that "since EVERYONE was on divert, to me that means YOU ALL are accepting patients, or are you refusing my patient and expecting me to transport the to --hmm-- Trenton? I can do that! Then I'll take a side trip up to DOH & OEMS and file a few complaints." I got a bed for my patient with an attitude from the nurse. Don't know her name, but I can pick her out of a line up.

You get texts on what hospitals are on divert and etc?? wow! tahst impressive! Wish we did!

We have hospitals here that are slow with only three patients there, I have brougth patients in and waited 10 minutes for a nurse, finally got one after I said "Am i invisible?"