The head of the region's paramedic service says offload delays are one of the biggest challenges they face these days.
Offload delay is the time paramedics spend taking a patient to the emergency department and waiting with them until a bed is free.
“It’s become common practice for paramedics to be waiting inside a hospital hallway with a patient, sometimes even for 10-12 hours,” says Stephen Van Valkenburg, chief of paramedic services for the Region of Waterloo.
Offload delays are rising as more people go to the emergency room or call for an ambulance.
“Emergency rooms are backed up because there aren’t enough available hospital beds for those who need them. Space is an issue and so is adequate staffing,” Van Valkenburg says.
“The emergency department often gets nailed with the cause of this. But that’s not true. It’s a whole hospital system and health care issue. The hospital can’t get people out to long term care or alternate level of care beds in the community."
Because there are no beds, that creates a backlog when patients come in. And paramedics are left to provide hallway medicine.
“When we bring patients into hospital, they should first be triaged so we can get our crews back on the road and hospitals should be taking responsibility of the patient as soon as we come through the door. Right now, it’s more of a shared-care model of responsibility," Van Valkenburg says.
The region released a performance report in May which showed 63,615 ambulance responses in 2021, a 10 per cent increase from the previous year.
Unit utilization has increased to 42 per cent while the target remained at 35 per cent as set out in the the Paramedic Services Master Plan.
Cambridge Memorial Hospital says it has partnered with the Region of Waterloo to have an offload nurse on site to help care for patients as they wait to be offloaded.
Nurses take patients from paramedics so the ambulances can get back on the road for other calls.
“With all healthcare staffing challenges, this assignment may not be filled regularly. Emergency does their best to ensure all patients are prioritized and cared for,” says Cambridge Memorial Hospital spokesperson Stephan Beckhoff.
“The offload delay is similar to when a person walks into emergency and is waiting to be registered and triaged. The ambulance attendants can’t leave the patient until a hand-off is completed. Some may perceive that by coming in by ambulance, this will result in being seen faster, it may not, as all patients are assessed and triaged according to the severity of their condition. Once offloaded, patients who are able to sit, may spend part of their visit in the waiting room. At all times, those who are sickest are always seen first.”
Van Valkenburg says there have been a couple programs put in place to help with offload delay.
“One program is called ‘fit to sit’, which has been in Waterloo Region for at least nine years. This means, bringing someone in from a residence or home, and if they are not in an immediate danger or threat, they can sit in the waiting room. They don’t have to wait on our stretcher and create an offload delay,” Van Valkenburg says.
The other program is called ‘doubling up’.
“This is where we leave two patients with one crew, so, the other can get back on the road.”
Van Valkenburg says the province needs to set expectations with the hospitals, to create incentives to help prevent offload delay because it has now become a ‘culture’ within the hospitals.
“That should not be the culture at all. We should be able to bring people in to hospital, and get them off our stretcher. That’s not happening.”
That is why Van Valkenburg is helping to sound the alarm when it comes to offload delays, and he hopes the province will listen.
But, Van Valkenburg says, there is no quick solution.
“I sit on the Ontario Association of Paramedic Chiefs. We have formulated a two-page document that’s being distributed to politicians, outlining the whole issue of hospital delay. Paramedics are the only health-care professionals that can take health care to the streets and to the people in their homes,” he says.
“It’s become a public safety issue where all of our ambulances and all of crews are tied up in the emergency department and then we can’t respond to a 911 call from the community. We want to make sure the message is heard clearly. We’ve been advocating for years and this issue goes back almost 17 years now.”
But, Van Valkenburg says, every hospital is in a different situation.
“You can’t compare them. It all depends on how many hospital beds there are, do they have an offload nurse program, do they have enough staff, and do they have a shortage of beds? There are so many different factors, and the issue is very complex,” he says.
“You can’t just point the finger in one area and think that it will be fixed. But we want to make sure that there is a province-wide approach. The Ontario Association of Paramedic Chiefs wants to make sure of this. We consider the offload nurse program, a Band-Aid solution for this problem. We need a much heartier solution to this.”
Van Valkenburg says that the province needs to come to the table and recognize that offload delay is a health and public safety risk.
“There is some onus on the hospitals. There are hospitals, for example, in New Brunswick and some in Ontario, that have been able to solve their offload issues. So there are lessons to be learned.”
Van Valkenburg says there needs to be a whole hospital approach.
“It’s not just about emergency solving the backlog in their department. It’s a mobility issue of getting patients in the hospital and out of the hospital. This is why it’s a healthcare and system issue,” he says.
“We’ve tried all sorts of different things, but we have definitely taken a different approach now in being more aggressive in saying that we can’t solve this problem.
“We are being much more vocal about this,” Van Valkenburg says.
‘We will work in collaboration with the hospitals and government to try and resolve this, but ultimately, it is not a problem the paramedic services alone, can solve.”
