West Virginia Ambulance Authority Begins Cutting Ambulance Wait Time

Study found 80 percent of available ambulances were stuck outside of hospitals.


ZACK HAROLD, Charleston Daily Mail | | Wednesday, August 15, 2012

It seems like a simple conclusion: If ambulances are stuck at a hospital waiting to drop off a patient, they can't be on the way to a heart attack patient's home or heading to the scene of a car wreck.

But Dr. John Turley, medical director for the Kanawha County Emergency Ambulance Authority, said hospital staff just never considered it.

"It's one of the things the hospitals never paid attention to. They had so many other requirements they had to meet, (administrators felt) 'if nobody said anything to me about it, I'm not going to worry about it,' " he said.

Turley, who also works in Charleston Area Medical Center's Memorial Hospital emergency department, said ambulances sometimes waited more than two hours to offload patients before getting back on the road.

"We had reports of some, three or four hours in waiting," he said.

He said a study conducted in Kanawha County a few years ago found that at times 80 percent of available ambulances were stuck waiting outside emergency rooms.

Hospitals are not wholly to blame, said Kim Johnson, quality assurance director for the ambulance authority. Patients often abuse ambulance services, causing a backlog.

"You have to remember, people will call an ambulance for anything, and we have to transport. If you call and say, 'I've cut my finger,' and you request transport, we have to transport," she said.

Turley said some people, usually those without any other means of transportation, call ambulances for afflictions as minor as a sprained ankle or a toothache. He once saw a patient arrive in an ambulance with a case of poison ivy.


Now, the ambulance authority is cracking down on wait times.

Officials met with area hospitals in April to discuss the problem. And the hospitals - Charleston Area Medical Center's General, Memorial and Women and Children's hospitals, along with Thomas Memorial and St. Francis hospitals - promised to shorten the waits.

There have been some improvements.

In June 2011, about 7 percent of ambulances at General Hospital's emergency room waited 60 minutes or longer before offloading a patient. In July 2012, the most recent available data, just 2 percent of ambulances waited that long.

At CAMC Memorial, 4 percent of ambulances waited longer than an hour to offload patients in June 2011. Last month, only 2 percent waited that long.

Three percent of ambulances at St. Francis Hospital's ER waited 60 minutes or longer in June 2011. Only 1 percent waited that long last month.

Thomas Memorial's offload times have slipped a little since last year. In June 2011, 99 percent of ambulances left the ER there in less than 60 minutes. In July, about 4 percent waited longer than an hour.

Ambulance authority officials still aren't satisfied with the results.

"It is our goal in the future to offload all patients in 20 minutes or less 90 percent of the time and 30 minutes or less 100 percent of the time, but this won't happen for a while," Johnson said in an email.

In July, 15 percent of ambulances at General, 24 percent of ambulances at Memorial, 20 percent of ambulances at Thomas and 12 percent of ambulances at St. Francis waited longer than 30 minutes to offload patients.

"We're not where we need to be yet," Turley said.

Changing the rules

He estimates between 30 and 40 percent of patients who arrive via ambulance do not actually need emergency transport. Under old regulations, crews had to wait with patients until they were admitted to the ER, even if they didn't need emergency care.

The ambulance authority now has changed those rules. Ambulance crews now can offload those non-emergency patients to the emergency department's waiting room, as long as they make contact with the ER's charge nurse.

"If it's not a real emergency, they are giving reports to the charge nurse in the ER and dropping the patient off in the emergency room where they get in line with other patients," said Bob Gray, vice president of business development for Thomas Memorial.

Thomas has one of the busiest ERs in the county, Gray said. Of the 1,138 patients transported by ambulances in June, Thomas received 502 of them.

Sometimes that high volume can clog up the works.

"I've got 30 beds in my ER. There have been days when the hospital is completely full and I've got 14 or 15 patients in the ER waiting to go to a bed," Gray said.

To combat the problem, Thomas opened an additional nursing unit with 15 extra beds for patients waiting to be admitted to the hospital. That frees up beds in the emergency room and allows ambulances to offload more patients.

Gray said the hospital also has started doing some lab tests in the emergency room. That cuts down on wait time and helps staff process patients more quickly.

CAMC spokesman Dale Witte said each of the system's hospitals are working independently to reduce offload times.

"Each one is different," he said.

General's emergency room is CAMC's busiest, Witte said, because it gets all the trauma patients from car wrecks or other accidents, as well as stroke patients. Memorial Hospital's ER generally deals with heart and respiratory issues.

Turley said CAMC hasn't made many changes to its procedures to improve offload times, other than to focus on the issue.

"Every month we're making significant improvements. We're very seldom exceeding 40 minutes now," he said.

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