- Just because the patient arrives by ambulance does not mean that they require an immediate ED bed. Many such patients can safely be taken to the waiting room and triaged along with the patients who arrive on their own. Mode of arrival is not a triage category.
- Patients awaiting an inpatient bed should be sent to an upstairs hallway as soon as their bed is assigned, and they should not be made to wait in the ED for housekeeping to clean their room. Once the previous patient has been discharged, the unit has capacity for a new patient, whether or not their room is ready for them.
- Assign a physician or advanced practice provider to the waiting room to conduct rapid medical screening exams and to manage the volume of low-acuity patients that can be safely discharged without ever occupying an ED bed. Simple tests such as urinalysis, chest X-ray, or extremity X-rays can be ordered, completed, and interpreted with the disposition made from the waiting room.
- Many ED patients who require a bed for part of their stay do not require a bed for their entire stay. Patients with low-acuity conditions such as abdominal pain or flank pain, for instance, can be examined, have labs drawn, be medicated, and have tests performed. Once they have clinically improved or their evaluation is completed, they can be moved to a discharge lounge or waiting room to await their results, their paperwork, a social work consult, or their ride home without continuously occupying an ED bed.
- Create an ambulance–patient waiting area for those patients who cannot go to the main ED waiting room. Staff it with hospital staff who are, unlike EMS workers, credentialed to observe patients in the hospital, and release the EMS personnel back to the community.
- Lastly, a hospital that is so overwhelmed that it must hold ambulances for hours at a time and has exhausted all other options, should be activating its disaster plan.
Some EMS systems have employed EMTs and paramedics to “mind” EMS patients in the ED. This is a poor solution, costing the EMS system money and personnel better deployed responding to calls. If EMS-employed EMTs can watch a patient, then hospital-employed EMTs (or staff such as certified nursing assistants and licensed vocational nurses, among others) can watch a patient. Techniques like these allow one very busy, high-acuity ED of 65 beds seeing around 100,000 patients per year to never hold ambulances.
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ACEP Now: Vol 43 – No 12 – December 2024Pages: 1 2 3 | Single Page
One Response to “Strategies to Reduce Ambulance Patient Offload Delays”
January 8, 2025
EvUnfortunately, in many hospitals we’ve already exhausted all of those options and still getting overwhelmed with ambulance traffic. I work in a 30 bed ED that typically has 20+ boarded inpatients and still receiving 30+ ambulances on a typical night shift. We already utilize most of these strategies (other than waiting room/triage MD/PA as we don’t have the staffing to add that as an extra shift). No option to go on divert as the nearest alternate ED is 2 hours away. Lots of pressure from hospital leadership and above to get the ambulances offloaded, so often a CTAS 3 who arrived by ambulance 2 hours ago will get roomed prior to a CTAS 2 who has been in the waiting room for 6-8 hours. Sometimes we’ll even take over the ambulatory care clinic behind the ED to house admitted inpatients at night so we have space to see ED patients, but we have to vacate by morning.
To me another solution that needs to be included is that the entire hospital shares the burden. More patients need to be boarded in hallways upstairs so that the ED can still function. Ten inpatient ward nurses having to take one extra patient each is certainly safer than and the ED nurses having to carry 4-5 inpatients in addition to taking care of a full load of ED patients who are being stuffed into every nook, cranny, and broom closet in the ED.