When the emergency department census is high and a hospital is operating at capacity, EMS crews may wait hours to transfer lower-acuity patients to an ED provider. This prolonged wait time decreases the availability of ambulance services to the community.
Trauma and ED leaders at Providence St. Peter Hospital, a Level III trauma center in Olympia, Washington, solved this problem through a unique collaboration with the local county EMS agency. According to Wendy Rife, trauma program manager, the collaboration allowed ambulance crews to transfer lower-acuity patients more quickly and get back on the street sooner.
Challenge: Long wait times mean EMS crews are unavailable
“Since 2018, our emergency center has experienced a growing number of inpatient boarders occupying emergency room beds and space. In December 2022, for example, a typical day might begin with 45 to 50 boarders in a 44-bed ED. This has resulted in a backlog of patients waiting to see a provider in both the waiting room and in the hallways. EMS crews would be lined up in the ED hallways, waiting for hours to hand the patient over to ED staff. Some lower-acuity patients who arrived by EMS waited as long as 6 hours to be handed off to a nurse once one was available. The trickle-down impact to the community was less EMS availability.”
Innovation: Staff ED entryway with 2 EMTs
“In January 2023, we partnered with Thurston County Medic One to trial staffing our ED EMS entryway with 2 emergency medical technicians (EMTs) during peak hours. Incoming BLS crews can hand off up to 4 patients to the EMTs in the ambulance bay and then return to service. These patients must be stable and meet specific criteria. The EMTs take report from the BLS crews and monitor the patients until the charge nurse is able to secure an ED bed. Patients continue to receive pre-hospital monitoring by experienced EMTs in accordance with the agency’s approved protocols, and the EMTs document their monitoring in their electronic pre-hospital medical record. Once a bed opens up, the EMT hands the patient off to an RN and the ED staff. In the event of patient decompensation, the charge nurse is notified immediately for re-evaluation.”
Results: In 7-week period, regained 50 hours of EMS availability
“The average EMS turnaround time at our hospital during the fourth quarter of 2022 was 31.55 minutes. For the first 7 weeks of 2023, the average was 27.28 minutes. That is a 13.5% reduction in EMS turnaround times. When you apply that to the 704 public transports to St. Peter Hospital during this 7-week period, it represents more than 50 hours of ambulance availability gained back by EMS.”