1. #1
    Join Date
    Mar 2011

    Default Solutions for delayed offload times

    I manage an ambulance service in a busy metropolitan area. For years we have endured substantial delays in offloading our patients to ED gurneys. Wait times more than an hour are not uncommon. We have even had situations where we had no available ambulances to respond to emergencies while more than a dozen of our ambulances are tied up waiting for ED beds. Yesterday, I was at one of the hospitals attending a luncheon where the new ED stroke protocol was reviewed. While this was going on, we have a crew waiting in the ED hallway for 2 hours, 24 minutes with a woman suffering stroke symptoms.

    We have tried everything we can think of to fix the problem. We have met with hospital administration, provided data and evaluated process. Our local EMS Agency director even resorted to turning in a local hospital on an EMTALA violation. Nothing has worked. We've considered turning patients over to our own crews and monitoring them ourselves (first in, last out), but we can't seem to figure out the logistics of where to store extra gurneys or how to move the patients within the ED.

    Can anyone out there please offer examples of solutions that have worked for them? Has anyone successfully billed the hospitals for their wait times?

    I look forward to your thoughtful responses and a serious dialogue on this problem.

  2. #2
    Join Date
    Mar 2008
    Pittsburgh, PA


    I can't offer any tested solutions because we don't have this problem here, but I do know a thing or 2 about hospital administrators and their motivations.

    First, get good, solid data (if you don't already have it). What % of crews wait >15 min, what is the average wait, etc. Get it by hospital so you can point to one facility as being worse than the other, or whatever.

    Next, re-meet with the hospitals. If you discover that one hospital is a bigger problem than the others, talk about policy changes that would divert pts away from that hospital. Nothing is more frightening to a hospital than potential lost revenue....

    (Also, consider arranging policies between your service and the hospitals that would allow certain pts to go to the waiting room or a triage nurse, rather than back into an ED bed. I'm sure you have more than a few pts who could have gone by taxi, time to start putting them into the regular line with the pts who did come by car. Our local services divert pts to triage all the time.)

    As a last resort, if you have a reasonable relationship with the local media, start dropping hints about how much time the local ambulances spend out of service, then give them the data you've already developed. The only thing hospitals hate as much as lost revenue is bad publicity.
    Disclaimer: dr-exmedic is just a resident. Give him a break.

  3. #3
    Join Date
    Aug 2002
    Wake Forest, NC USA

    Default Just say no!

    First, if the problem is egregious, you've tried to fix it, and it persists, I'd consider contacting the EMTALA police - your regional CMS folks. There is a letter out there on the web from the Atlanta CMS folks detailing that delays in providing examination and treatment are EMTALA violations.

    Second, don't take patients there. Are you doing what's good for your patients by taking them to somewhere that can't (won't) help them?



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