Like many EMS agencies across the country, Nash County EMS in North Carolina was facing challenges caused by rising call volume and busier emergency departments. From 2014 to 2015, the number of patients transported by Nash County EMS increased by nearly 35%, according to Scott Strufe, the EMS director.
Nearly all of the emergency transports were to Nash-UNC Healthcare, just outside of the county’s largest city, Rocky Mount. Over the last several years, Nash-UNC Healthcare has been the fifth busiest ED in North Carolina, coming in ahead of hospitals in some of the state’s largest cities. In response, the hospital built a new, larger ED. But demand continued to grow.
In 2013, Nash County EMS leaders were happy with the agency’s hospital turnaround times. The service was aiming for a 20-minute turnaround time and averaging just over its goal. Between July 2014 and June 2015, as transport requests and 9-1-1 calls increased, the average turnaround time rose dramatically to more than 30 minutes. During that time, the agency also began using its ePCR software’s analytical package to track turnaround times, among other measures.
A difference of nine and a half minutes might not seem so significant, especially when the service was simultaneously responding to a huge increase in transport volume. But with 11,000 transports each year, Nash County EMS units were spending 100,000 extra minutes at the hospital. That’s 1,766 hours. or 73 days. that ambulances were not available to respond to calls.
Strufe said these delays also impacted crew morale and confidence since they led to longer response time to other calls and created patient care concerns. Other indirect costs associated with hospital offloading delays include the cost of paying highly trained EMS caregivers to sit and wait at the hospital.
While Nash County’s efforts to reduce hospital turnaround time remain a work in progress, Strufe said, from July to October 2015 the agency was able to decrease turnaround times from a little over 30 minutes to less than 26 minutes.
Strufe offered five tips for EMS services looking to bring down turnaround times based on Nash County’s experience tackling the problem.
1. Look internally first
The first question Nash County EMS leaders asked was, “Are we causing this delay?” The leadership wanted to know what could be changed internally to address the problem and examined which internal processes could be improved and whether individual employees’ hospital times varied.
2. Bring all the stakeholders together
Next, Nash County EMS administrators and the medical director met with hospital executives and ED leaders to discuss the rising turnaround times and the domino effect slow turnaround times have on other EMS units and patients.
3. Use data to illustrate the issue
Nash County EMS illustrated the problem to the stakeholder groups by using the data the agency had collected—a simple analysis using ESO Analytics software produced a regression line to show that turnaround times had steadily climbed throughout the year.
4. Have regular follow-up meetings
At monthly performance meetings, EMS and ED staff review the issue of turnaround times and how to make improvements.
5. Empower your employees to make change
The Nash County EMS team made it a point to provide employees with information about the problem of creeping turnaround times and the power that each individual has to impact the total times.
Susanna J. Smith is a content strategist and freelance writer who focuses on the future of healthcare and how new technologies and care models are reshaping the healthcare industry. She holds a master’s in public health from Columbia University and has worked as a writer, editor and researcher for more than 10 years. Follow her work at @SusannaJSmith and susannajsmith.com.