Ambulance Personnel and wait times

[Kince]

Hello all,

I'm working part time with the local ambulance service and as a dedicated employee have had a wonderful opportunity to study the finer details of the ED waiting room paint job and interior decor. By this I mean, I generally spend 2-3 hours per green-->amber patient being triaged before being relieved. This is a duty I see as necessary, as certainly (in my region) leaving even a green patient in the waiting room without signing them off would legally be considered abandonment.

I'm just wondering how the ED's in your areas of the world handle stretcher bound patients. Do the paramedics and ambulance personnel wait hours being triaged? Do you have a special stretcher bay so the crews can hit the road again?

I was in the ED for 6.5 hours today with a green patient. It was so busy, infact, we ended up having our patient treated while in the stretcher, we transported the patient ourselves to CT scan, and then only then upon completion did we offload to an emergency treatment room.

I'm interested to know. Especially from the big centres where volume is high.

[mced]

I pull shifts in a 50+ bed ED where it is not unusual for 4-6 rescues to be waiting in our bay. We triage the patients as you bring them in and will find a way to get a bed if the patient is truly on their way to meet Jesus. Otherwise we usually send them to the waiting room and order labs, ecg, etc (pending you have not already put a line in them). If the patient has a line and we have no rooms or hall stretchers open you end up having to wait. Longest wait for EMS I have personally seen is roughly four hours. It is actually quite funny the amount of patients that check in through our triage, get tired of waiting, and then go home to call you guys for a ride to the hospital. I have even seen a few that call 911 directly from our ED waiting room. Complete drain on the system.

[RoxanRN]

In the Level I Trauma Center where I work (worked as a tech in the ER, now RN in ICU), it is extremely rare for a crew to have to wait for a bed (even a hall bed) for more than 20 minutes. If they bring in a 'triage to the waiting room' patient, they slip to the head of the triage line in order to be able to give a quick report to the RN. However, the patient is placed in the que based on the time they arrived and severity of injury/illness (just like everyone else). Making the ambulance crew wait for hours is not something which happens here. They couldn't financially afford to operate that way. But once in the waiting room, it's not unusual to have waits of up to (and occasionally exceeding) 6-8 hours.

Now before everyone goes and tells me we have it easy (well, maybe we do ), we have 2 Level I Trauma Centers in town as well as a large non-trauma certified ER (they also happen to have the psych intake facilities).

[Altra, BSN, RN]

In the Level I Trauma Center where I work (worked as a tech in the ER, now RN in ICU), it is extremely rare for a crew to have to wait for a bed (even a hall bed) for more than 20 minutes. If they bring in a 'triage to the waiting room' patient, they slip to the head of the triage line in order to be able to give a quick report to the RN. However, the patient is placed in the que based on the time they arrived and severity of injury/illness (just like everyone else). Making the ambulance crew wait for hours is not something which happens here.

Now before everyone goes and tells me we have it easy (well, maybe we do ), we have 2 Level I Trauma Centers in town as well as a large non-trauma certified ER (they also happen to have the psych intake facilities).

I'm with you Roxan, having crews wait as the OP described just does not happen here. But I'm in a city w/3 Level I trauma centers and multiple other hospitals as well.

[EricJRN, MSN, RN]

Sheesh! Now I feel fortunate to volunteer for a system where I might only be flat-out ignored at the ER for 20-30 minutes. 6.5 hours? There have been a couple of times where our crews have waited 45 min to an hour. Even at that point, I'm always tempted to call a shift supervisor and have them bring us the stretcher out of our backup unit, leave the current pt on the stretcher (since we've usually already given report), and go back in service. Notice I say 'tempted' - never actually tried it and I know it's not without ethical, legal and customer service considerations.

[LeahJet, ASN, RN]

It is actually quite funny the amount of patients that check in through our triage, get tired of waiting, and then go home to call you guys for a ride to the hospital.

Yep....and it's even more funny when they get hauled in, then sent back to the waiting room.....losing their place in line.~evil grin~

[NeuroMedic]

Thank God our rigs have backdoor access(with a code of course) straight into

the ER without even passing a waiting room. We take them in; get a sign off--and boom; back to the field.

[RoxanRN]

I think that is the norm everywhere.....

[rjflyn, ASN, RN]

Here the police will arrest a patient if they leave the ED and call 911. Our medics on occasion 2-3 times a 12hr shift will bring patients to the lobby. Generally they have gotten the once over by the charge nurse and in combination with the radio report they gave the go to th lobby, the run ticket is left with the triage staff and they make sure the patient has been signed in to the system.

The look you one gets when a police officer tells a patient thats waiting in an exam room, their chart 10+ patients deep in the rack for the docs to see and they say they will just leave and call 911 and he tells them they will be going to jail and not here. PRICELESS.

Rj

I pull shifts in a 50+ bed ED where it is not unusual for 4-6 rescues to be waiting in our bay. We triage the patients as you bring them in and will find a way to get a bed if the patient is truly on their way to meet Jesus. Otherwise we usually send them to the waiting room and order labs, ecg, etc (pending you have not already put a line in them). If the patient has a line and we have no rooms or hall stretchers open you end up having to wait. Longest wait for EMS I have personally seen is roughly four hours. It is actually quite funny the amount of patients that check in through our triage, get tired of waiting, and then go home to call you guys for a ride to the hospital. I have even seen a few that call 911 directly from our ED waiting room. Complete drain on the system.

[paccookie]

Thank God our rigs have backdoor access(with a code of course) straight into

the ER without even passing a waiting room. We take them in; get a sign off--and boom; back to the field.

That's what happens at my hospital too. Our EMS is so busy that they *can't* wait longer than a few minutes once the patient has arrived. If they aren't busy, sure, they don't mind sticking around but the ER staff is pretty good about taking over the pt right away. And yes, it's hilarious to see how angry they get when they get triaged to the waiting room. LOL

Christina

[vampiregirl, BSN, RN]

Wow- I can't even image waiting hours to turn a patient to the ER staff... I've been an EMT for over 8 years and haven't ever waited over 10 minutes to turn over a patient.

I think it also helps that we turn over a "patient care worksheet" with all of our patients. We fill it out on the way to the hospital (our typical transport time is 20 minutes to the closest hospital). It lists med history, meds, allergies, assessment results/ symptoms and any interventions we perform.

[andhow5, BSN, RN]

I love the looks on faces when we boot them off the arriving EMS cot and make them hoof it out to the waiting room, LOL! ~wicked evil grin ~

Usually we're pretty good abut taking report immediately and getting our awesome EMS crews back out into the jungle. (Now if only they'd unload at the zoo...)