57 times in past six months, no ambulances were available in the city

News Oct 23, 2009 Ancaster News

While a report earlier this month showed Hamilton’s emergency response times improved by 36 seconds between January and June 2009 compared to last year, it also showed that in those six months, the city had 57 code zeros –an increase of two over the same time the year before.

A code zero is when there are one or no transport ambulances available in the city.

Brent Browett, manager of emergency medical services, predicted that by the end of this year, Hamilton would have about 100 code zeros, about the same amount as in 2008.

Mr. Browett points out that even when an ambulance is unavailable, an emergency response vehicle attends to calls. These paramedic units, one for each of six zones in Hamilton (three above the escarpment and three below), respond to calls, but do not transport patients to hospital. The fire department can also respond and firefighters are trained in defibrillation, First Aid and CPR.

Mr. Browett said multiple factors cause a code zero, including the time it takes an ambulance to get to a call, the time spent at a call, the time to transport a patient to hospital and the time a paramedic spends at the hospital. According to the Ambulance Act, a paramedic must remain with a patient until the hospital emergency department staff agrees to accept care of the patient.

The first three factors have remained consistent over the past few years, but time spent at the hospital has increased. In the first six months of this year, paramedics spent an average of 52:31 in the emergency room.

The good news is, EMS has seen an improvement in recent months, due to initiatives at area hospitals.

Ida Porteous, administrative director at St. Joseph’s Healthcare Hamilton, says reducing emergency department wait times in general is a priority of all city hospitals, the Local Health Integration Network and the Ministry of Long- Term Care.

For its part, St. Joe’s is working with Toyota to improve efficiency. Toyota, which has worked with other North American hospitals, is translating lessons learned on the assembly line to health care. The car company is providing the advice free of charge, asking St. Joseph's to pay travel expenses for its staff.

“We have seen advances, now we need to sustain them,” Ms. Porteous said.

The Hamilton Niagara Haldimand Brant LHIN also received $5,571,500 from the province for its hospitals to reduce ER wait times through the Pay-for- Results program, which gives funding incentives to meet specific targets. To take patients out of the ER until they are placed in an inpatient bed, St. Joe’s has an express unit with beds designated for short-term use; rapid assessment zones evaluate less complicated cases; and physicians and staff have rapid rounds every day to discuss each patient’s potential for discharge.

“That way they don’t linger in beds longer than needed. We can even anticipate their release a few days before,” Ms. Porteous said. “If we can anticipate, we can better plan.”

As well, staff dedicated to patient flow meet many times a day regarding bed management. Medically stable patients who need help to regain their strength are placed in Assess and Restore beds at St. Joseph’s Villa in Dundas.

“These steps are making a difference. Will it be enough to substantially reduce wait times? That is still the question,” said Ms. Porteous, adding improved times are more difficult to sustain depending on events in the community, such as a flu outbreak.

Isabel Hayward, program director, acute medicine, emergency and pre-hospital care, Hamilton Health Sciences, also stresses that hospital offloading times are not the only reason for code zeros. For example, if many ambulances are needed to attend to a major accident, that also affects resources.

HHS also uses express units with eight beds, which are open for 12 hours at certain times in the morning, to take patients waiting to be admitted.

"These patients are normally waiting in the ER during discussions and not moved until late afternoon," Ms. Hayward said.

Through a health ministry grant, city hospitals also hired nurses who take over the care of incoming ambulance patients during peak periods and coordinate patient flow. Ms. Hayward said these nurses made a definite positive impact, but unfortunately funding only covers five months of the year. HHS chose to have the nurses work from November to January and March and April.

57 times in past six months, no ambulances were available in the city

News Oct 23, 2009 Ancaster News

While a report earlier this month showed Hamilton’s emergency response times improved by 36 seconds between January and June 2009 compared to last year, it also showed that in those six months, the city had 57 code zeros –an increase of two over the same time the year before.

A code zero is when there are one or no transport ambulances available in the city.

Brent Browett, manager of emergency medical services, predicted that by the end of this year, Hamilton would have about 100 code zeros, about the same amount as in 2008.

Mr. Browett points out that even when an ambulance is unavailable, an emergency response vehicle attends to calls. These paramedic units, one for each of six zones in Hamilton (three above the escarpment and three below), respond to calls, but do not transport patients to hospital. The fire department can also respond and firefighters are trained in defibrillation, First Aid and CPR.

Mr. Browett said multiple factors cause a code zero, including the time it takes an ambulance to get to a call, the time spent at a call, the time to transport a patient to hospital and the time a paramedic spends at the hospital. According to the Ambulance Act, a paramedic must remain with a patient until the hospital emergency department staff agrees to accept care of the patient.

The first three factors have remained consistent over the past few years, but time spent at the hospital has increased. In the first six months of this year, paramedics spent an average of 52:31 in the emergency room.

The good news is, EMS has seen an improvement in recent months, due to initiatives at area hospitals.

Ida Porteous, administrative director at St. Joseph’s Healthcare Hamilton, says reducing emergency department wait times in general is a priority of all city hospitals, the Local Health Integration Network and the Ministry of Long- Term Care.

For its part, St. Joe’s is working with Toyota to improve efficiency. Toyota, which has worked with other North American hospitals, is translating lessons learned on the assembly line to health care. The car company is providing the advice free of charge, asking St. Joseph's to pay travel expenses for its staff.

“We have seen advances, now we need to sustain them,” Ms. Porteous said.

The Hamilton Niagara Haldimand Brant LHIN also received $5,571,500 from the province for its hospitals to reduce ER wait times through the Pay-for- Results program, which gives funding incentives to meet specific targets. To take patients out of the ER until they are placed in an inpatient bed, St. Joe’s has an express unit with beds designated for short-term use; rapid assessment zones evaluate less complicated cases; and physicians and staff have rapid rounds every day to discuss each patient’s potential for discharge.

“That way they don’t linger in beds longer than needed. We can even anticipate their release a few days before,” Ms. Porteous said. “If we can anticipate, we can better plan.”

As well, staff dedicated to patient flow meet many times a day regarding bed management. Medically stable patients who need help to regain their strength are placed in Assess and Restore beds at St. Joseph’s Villa in Dundas.

“These steps are making a difference. Will it be enough to substantially reduce wait times? That is still the question,” said Ms. Porteous, adding improved times are more difficult to sustain depending on events in the community, such as a flu outbreak.

Isabel Hayward, program director, acute medicine, emergency and pre-hospital care, Hamilton Health Sciences, also stresses that hospital offloading times are not the only reason for code zeros. For example, if many ambulances are needed to attend to a major accident, that also affects resources.

HHS also uses express units with eight beds, which are open for 12 hours at certain times in the morning, to take patients waiting to be admitted.

"These patients are normally waiting in the ER during discussions and not moved until late afternoon," Ms. Hayward said.

Through a health ministry grant, city hospitals also hired nurses who take over the care of incoming ambulance patients during peak periods and coordinate patient flow. Ms. Hayward said these nurses made a definite positive impact, but unfortunately funding only covers five months of the year. HHS chose to have the nurses work from November to January and March and April.

57 times in past six months, no ambulances were available in the city

News Oct 23, 2009 Ancaster News

While a report earlier this month showed Hamilton’s emergency response times improved by 36 seconds between January and June 2009 compared to last year, it also showed that in those six months, the city had 57 code zeros –an increase of two over the same time the year before.

A code zero is when there are one or no transport ambulances available in the city.

Brent Browett, manager of emergency medical services, predicted that by the end of this year, Hamilton would have about 100 code zeros, about the same amount as in 2008.

Mr. Browett points out that even when an ambulance is unavailable, an emergency response vehicle attends to calls. These paramedic units, one for each of six zones in Hamilton (three above the escarpment and three below), respond to calls, but do not transport patients to hospital. The fire department can also respond and firefighters are trained in defibrillation, First Aid and CPR.

Mr. Browett said multiple factors cause a code zero, including the time it takes an ambulance to get to a call, the time spent at a call, the time to transport a patient to hospital and the time a paramedic spends at the hospital. According to the Ambulance Act, a paramedic must remain with a patient until the hospital emergency department staff agrees to accept care of the patient.

The first three factors have remained consistent over the past few years, but time spent at the hospital has increased. In the first six months of this year, paramedics spent an average of 52:31 in the emergency room.

The good news is, EMS has seen an improvement in recent months, due to initiatives at area hospitals.

Ida Porteous, administrative director at St. Joseph’s Healthcare Hamilton, says reducing emergency department wait times in general is a priority of all city hospitals, the Local Health Integration Network and the Ministry of Long- Term Care.

For its part, St. Joe’s is working with Toyota to improve efficiency. Toyota, which has worked with other North American hospitals, is translating lessons learned on the assembly line to health care. The car company is providing the advice free of charge, asking St. Joseph's to pay travel expenses for its staff.

“We have seen advances, now we need to sustain them,” Ms. Porteous said.

The Hamilton Niagara Haldimand Brant LHIN also received $5,571,500 from the province for its hospitals to reduce ER wait times through the Pay-for- Results program, which gives funding incentives to meet specific targets. To take patients out of the ER until they are placed in an inpatient bed, St. Joe’s has an express unit with beds designated for short-term use; rapid assessment zones evaluate less complicated cases; and physicians and staff have rapid rounds every day to discuss each patient’s potential for discharge.

“That way they don’t linger in beds longer than needed. We can even anticipate their release a few days before,” Ms. Porteous said. “If we can anticipate, we can better plan.”

As well, staff dedicated to patient flow meet many times a day regarding bed management. Medically stable patients who need help to regain their strength are placed in Assess and Restore beds at St. Joseph’s Villa in Dundas.

“These steps are making a difference. Will it be enough to substantially reduce wait times? That is still the question,” said Ms. Porteous, adding improved times are more difficult to sustain depending on events in the community, such as a flu outbreak.

Isabel Hayward, program director, acute medicine, emergency and pre-hospital care, Hamilton Health Sciences, also stresses that hospital offloading times are not the only reason for code zeros. For example, if many ambulances are needed to attend to a major accident, that also affects resources.

HHS also uses express units with eight beds, which are open for 12 hours at certain times in the morning, to take patients waiting to be admitted.

"These patients are normally waiting in the ER during discussions and not moved until late afternoon," Ms. Hayward said.

Through a health ministry grant, city hospitals also hired nurses who take over the care of incoming ambulance patients during peak periods and coordinate patient flow. Ms. Hayward said these nurses made a definite positive impact, but unfortunately funding only covers five months of the year. HHS chose to have the nurses work from November to January and March and April.