London hospital ER changes cut ambulance drop-off delays by 70% – The London Free Press

The region’s largest hospital is changing how it handles incoming patients, including moving them to chairs in emergency rooms, an initiative that already has cut ambulance offload delays at its two ERs by nearly 70 per cent.
The region’s largest hospital is changing how it handles incoming patients, including moving them to chairs, to get ambulances back on the road faster, a strategy that’s cut offload delays by nearly 70 per cent.   

Patients arriving at London Health Sciences Centre (LHSC) emergency departments, by ambulance or otherwise, will be triaged and moved immediately to one of three spots: a care space for assessment and treatment, a hallway stretcher, or a chair, the hospital said Tuesday.  
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“If you come in by ambulance, there are different pathways. You may go directly to a care spot, because you need it. Or you may go to the horizonal wait room, which is a hallway care spot, on a stretcher,” said Christie MacDonald, the hospital’s emergency medicine physician lead.    

“Or, you may go from an ambulance stretcher to our vertical wait room, in a chair in our emergency department.” 

LHSC’s latest move standardizes patient handling at a time when hospitals across Ontario have been grappling with so-called hallway medicine, medical care delivered in hospital corridors due to lack of rooms, for many years.  

Though patients arriving in the emergency department may still encounter hours-long waits, documented in real time on the LHSC website, the strategy already has led to major improvements in the delays incoming ambulances are facing at both the University and Victoria hospital adult emergency departments.  

The plan, supported by Ontario’s Health Ministry, began in November and has, on average, cut a two-hour wait for paramedics down to less than 40 minutes in recent months, hospital officials said. The reductions in offload delays have been consistent and sustained since LHSC launched the new process, MacDonald said Tuesday.  
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It’s not the first time LHSC and the Middlesex London Paramedic Service have experimented with placing incoming ambulance patients deemed “fit to sit” in chairs instead of emergency room beds. The two organizations tested the plan in a six-month pilot project launched in fall 2019.  

Patients who find themselves placed in a chair post-triage could be in a few different locations, MacDonald said. Some are in the emergency room waiting room, others are in ER clinical areas. Patients who are given a chair instead of a bed may be receiving treatment, are monitored and are asked to report to medical staff if their condition changes, she said. 

“It’s important that families understand this as well. Our emergency department is tight. There may be times when their family members are with them for a short period of time and then are requested to go elsewhere due to space,” MacDonald said. 

Offload delays, the time an ambulance crew spends waiting to drop off a patient at the emergency room, have been a chronic issue in London. Anything more than 30 minutes from ambulance arrival to the patient’s transfer to the care of hospital staff is considered a delay. 

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Paramedics must hand over care of their patient to hospital medical staff. If an overrun emergency room can’t handle another intake, paramedics are forced to wait with the patient until the hospital is ready to receive them.   

Offload delay hours increased about 159 per cent in 2022 from the year before, the latest Middlesex-London Paramedic Service data show.   

Delays at London hospitals kept ambulances off the road for the equivalent of about 1,900 24-hour days in 2022.   

Bottlenecks at London emergency rooms also have been a factor in the number of “code zeros”, the term used when no local ambulances are available to take calls and crews from neighbouring regions, such as St. Thomas or Tillsonburg, are relied on to serve London-Middlesex.  

The number of patients heading to the emergency room, along with hospital bed and staffing pressures and restricted flow of patients out of the ER into inpatient beds, are key drivers of ambulance offload delays.   

Placing people arriving by ambulance in hallways to wait for care is already an affront to patient dignity, one local health care advocate said. Moving patients from an ambulance to a chair is a sign of the depressing state of affairs for Ontario’s hospital system, said Peter Bergmanis, chair of the London Health Coalition, a grassroots advocacy group. 

“This is another Band-Aid, not a real solution,” Bergmanis said, adding such a move would have been considered absurd even a decade ago.  

“No one is taking an ambulance to the ER for fun. These people need medical attention, not a chair.” 

LHSC, the region’s largest hospital, should use its position as a health care leader to demand better from the provincial government, Bergmanis said. 

“Instead of demanding to get the resources and the funding they need to retain and hire staff, they’re running around to try and make it work,” he said Tuesday.    

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