Abstract
Objective: We assessed the impact of emergency department (ED) paramedic staffing on emergency medical services (EMS) unit offload time, an intervention designed to assist with EMS unit patient offload when the ED is at full bed capacity. Methods: This prospective pre/post intervention study assessed patients offloaded via the regional EMS system at an urban tertiary care teaching hospital. Three groups were compared: 1) a pre-paramedic group with data obtained prior to any paramedics staffing the ED; 2) a transition (control) group with data obtained during paramedic orientation; and 3) a post-paramedic group with data measured after paramedics were staffing the ED. Research assistants stationed in the ambulance bay of the ED enrolled a convenience sample of patients for seven consecutive days and recorded offload time as patients were brought in by EMS. The primary outcome measure was offload time (the interval between patient arrival via EMS and transfer of patient care to an ED stretcher). Results: A total of 519 offloaded patients were assessed: 207 in the pre-paramedic period, 93 in the transition (control) period and 219 in the post-paramedic period. Overall median offload times (in minutes) in the preparamedic and post-paramedic groups were 10 [IQR 4-32] versus 4 [IQR 1-16] respectively (p<0.001). In those who were triaged directly to an ED bed the median offload times were 14 [IQR 3-40] and 4 [IQR 1-16] respectively (p<0.001). The proportion of patients offloaded within 5 minutes went from 29% before the paramedic intervention to 53% after (p<0.001). The proportion of patients offloaded within 30 minutes went from 66% before paramedics to 83% (p<0.001) after and those offloaded within 60 minutes went from 87% to almost 100% (p<0.001). Conclusion: An ED paramedic-staffing model focused on receiving EMS-arrived patients at times when the ED is at full bed capacity significantly reduced the offload time for EMS units.
Highlights
Nationwide emergency department (ED) crowding is a multifactor problem that has previously been well described in the literature [1,2,3]
This study assessed the impact of ED paramedic staffing on emergency medical services (EMS) unit offload time, an intervention designed to assist with EMS unit patient offload when the ED is at full bed capacity
This study demonstrates the positive impact emergency department paramedic staffing had on reducing EMS unit offload times
Summary
Reduced ED bed capacity leads to hospital diversion [4,5], a mechanism whereby EMS personnel are left caring for patients in their ambulances until another facility can be identified. These circumstances cause significant delays in transferring patients from emergency medical services (EMS) to definitive ED care [6]. When paramedics transport a patient to a crowded ED, they must wait in the ED with their patient on the ambulance stretcher until an ED stretcher becomes available These waits can span from a few minutes to several hours. Whether the cause is ambulance diversion or delayed offload of patients to a stretcher, when multiple ambulances are out of service communities are left in a state of reduced EMS availability to respond to 9-1-1 calls [6,7]
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