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March 30, 2016
ER delays frustrate Fla. paramedics
By Austin L. Miller
MARION COUNTY, Fla. — Hospital bed delays can be frustrating for everyone: emergency medical personnel, staff at hospitals and, of course, the patient and his or her family.
According to Marion County Fire Rescue, the local agency that transports the greatest numbers of patients for emergency medical care, the wait for an open bed can range from the optimal half-hour up to several hours.
The good news is, rescue and hospital officials have pledged to work together to solve the problem, and some plans already are in place to reduce the delays.
Why it matters
James Lucas, spokesman for Marion County Fire Rescue, said that from Jan. 1, 2015, through the end of February, service calls resulting in bed delays at hospitals have ranged from 427 to 1,083 per month, with very few days of zero delays.
The bed delays pose a problem for paramedics, who are expected to drop off patients with minimal problems and return to the road quickly to prepare for the next call. Ocala Fire Rescue does not transport patients to hospitals.
Lucas said that after arrival at a hospital, paramedics from his agency typically spend about 30 minutes with a patient before they leave the venue. Anything beyond that time is considered a bed delay.
“Crews often sit or stand with patients in hospital hallways for hours at a time,” he said.
The rescue workers are required to leave a patient with a hospital paramedic or a registered nurse. Delays occur when those personnel are busy with an influx of patients. Times of year when seasonal residents are here can be difficult; likewise for times with high levels of illness such as the flu.
Lucas said the greatest number of bed delays are registered on Mondays and Tuesdays; volume decreases on Saturdays and Sundays.
“Peak hours for bed delays generally start at 10 a.m. and start decreasing by 10 p.m.,” he added.
Officials from Munroe Regional Medical Center, which also operates the TimberRidge Medical Center, and Ocala Health, which owns Ocala Regional Medical Center and West Marion Community Hospital, are aware of the problem and said they are doing everything they can to remedy the situation.
“We’re aggressively recruiting ED (emergency department) staff, which has resulted in an increased number of paramedics, techs (technicians) and RNs (register nurses) in the emergency rooms,” said MRMC spokeswoman Michelle Zimmerman.
She said reasons for bed delays could include a lack of available space and “appropriately staffed beds.”
“Patient acuity plays a significant role in being able to place those arriving by EMS (Emergency Medical Services),” she added.
Acuity means the ability to see, hear or understand something easily.
Zimmerman said Munroe already has initiatives to cut down on bed delays that include an online check-in service. Where possible, the emergency department direct patients to come during less busy times of the day. It also diverts to other, less busy emergency departments.
Zimmerman said her organization is working to educate the community and create an awareness about what types of illnesses “necessitate a trip to the ED and what’s more appropriate for the primary care physician.”
ORMC officials said bed availability at their facilities varies from the day of the week and the time of the year.
“We work with our case managers and physicians to safely and appropriately discharge patients to provide beds for incoming patients,” said spokeswoman Brittney Marthaller. “Any treatments that can be started in the emergency room are initiated as soon as it’s safe for the patient.”
Marthaller said that in the last year they added 46 beds and plan to add another 44 beds in the next 18 to 20 months at their facilities in Ocala. In addition, the company's new 11-bed free-standing emergency room in Summerfield is slated to open before the end of the year.
At ORMC, there are 222 licensed beds, with 27 of those available for emergency room patients. At West Marion, there are 94 licensed beds, 22 of which are for ER patients.
MRMC has 421 licensed beds at the main hospital and 69 beds for its three emergency departments: 45 at the main campus, 15 at TimberRidge and nine at the Children’s ED.
According to MCFR's website, the agency became the countywide ambulance transport provider on Oct. 1, 2008, when the former ambulance service - the Emergency Medical Services Alliance - dissolved. County commissioners tasked the fire/rescue department with adding ambulance transport. With less than a year to plan, MCFR and county leaders established an operational plan, organizational structure, job descriptions and pay grades. The plan added 237 new positions, significantly increasing the number of ambulances in service. Today, MCFR employs more than 500 people and is the second largest fire rescue department north of Orlando.
Lucas said that if there should be an instance in which an ambulance crew has a bed delay at a hospital and there is an emergency call that involves, for example, a multiple-vehicle crash with serious injuries or multiple deaths, the agency will find a way to dispatch resources to that event.
“We have updated the rescue deployment plan to prioritize resources during peak call volume hours,” Lucas said.
In the case of a surge in need for care, Zimmerman said, “it’s an all-hands-on-deck attitude.” If someone is a licensed RN or paramedic working in a non-patient care area, she said, his or her “priority immediately becomes taking care of patients wherever you are needed.”
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