Ambulance offload time limits to be set at 5 busiest ERs in Nova Scotia

Senior officials responsible for running Nova Scotia's health system have been told to set time limits for ambulance offload times and emergency room stays, starting at five of the province's busiest ERs.

The Nova Scotia Health Authority is expected to deliver its new policy on maximum allowable times in roughly a month — a protocol the province's health minister said should help clear ER backlogs.  

"We know that people are staying too long, ambulances are staying in some of our busiest hospitals too long," Randy Delorey said Thursday.

The five emergency departments the province is targeting are the Halifax Infirmary, the Dartmouth General Hospital and hospitals in Sydney, Truro and Kentville. 

The minister credited front-line staff for suggesting the creation of maximum allowable times for offloading patients from ambulances and setting limits for how long it should take patients to be treated and released from the ER or transferred elsewhere.

"This is the information that they've brought forward, saying this is what we think we should be working towards, so I think it's prudent that I take their guidance," Delorey told CBC News.

Tim Guest, vice-president of the Nova Scotia Health Authority, told a legislature committee meeting devoted to emergency health services Thursday that work is well underway to reduce ambulance offload times. 

He pointed to the Dartmouth General Hospital as an example, where a team has been created to receive patients arriving by ambulance, which quickly frees up paramedics for the next call. 

Originally launched as a pilot project, the two-person teams are now in place permanently and similar units will soon start at the Valley Regional Hospital in Kentville.

Moving more patients through the ER

That hospital also has what's known as a rapid assessment zone, as does the Halifax Infirmary.

Guest described that as an area of the emergency department where patients are cared for, but moved around the hospital depending on their specific needs.

"If they are waiting for a lab or diagnostic imaging results, they may wait in a waiting area so they don't hold a stretcher up the entire time so you can get more people through [the ER]," he said.

That zone will soon be available around the clock in Halifax and be expanded to the Colchester East Hants Health Centre in Truro.

At some hospitals, nurses can also order lab and diagnostic imaging tests right from triage so that when a doctor finally sees the patient, those results are available.

"Our challenge is our emergency departments are at capacity already, so we're limited in the opportunities that we can do those sorts of initiatives," said Guest.

Emergency Health Services, which runs the province's ambulance service, and the Nova Scotia Paramedics Union said they see the potential for the new measures.

At any given time, 10 to 20 per cent of ambulance crews are tied up at hospitals waiting to transfer patients to staff, said Jeff Fraser, director of provincial operations of Emergency Health Services.

"These programs will [give] immediate relief to our paramedics and to our system, so we'll be able to get our ambulances back on the street," he said.

'It's going to have an impact'

Terry Chapman, business manager for the Nova Scotia Paramedics Union, echoed Fraser's optimism.

"Significant relief to me is making at least 50 per cent of [the backlog] go away," he said.

However, Fraser warned improving offload times would not solve the problem.

"From my experience in the system ... if you have 50 resources, there will be a time today where we will need 51," he said. 

Guest also said "the real issue" is getting people out of hospital beds and back into the community.

"There are an increasing number of individuals who need housing or accommodation or care, but their needs are becoming very complicated and the options are very few and far between," he said.

"We have some individuals that are staying in hospital for extended periods of time because it's very challenging for us to find locations for them to go."