EMSA Reports Waiting 2,500 Hours in 5 Months

EMSA ambulance crews spent more than 2,500 hours during the past five months waiting with patients they transported to Tulsa emergency rooms because no beds were available, a new study shows.

Paramedics could have spent those 2,500 hours on the street responding to emergency calls, said Dr. Jeffrey Goodloe, medical director of the Medical Control Board.

The 11-physician Medical Control Board establishes medical standards of care for first responders working for EMSA and fire departments that make up the EMS system for Oklahoma City, Tulsa and surrounding areas.

The Emergency Medical Services Authority is a government agency that oversees a private contractor, Paramedics Plus, that provides ambulance service to more than 1.1 million people statewide.

EMSA gathered and analyzed data on patient transports to 20 hospitals in Tulsa and Oklahoma City from Jan. 1 through May 31. The study, done at the request of the Medical Control Board, defined a bed delay as a transport in which paramedics waited with patients in an emergency room for a bed to become available.

During the five months studied, EMSA paramedics waited 2,880 hours during 5,568 individual patient transports for beds to become available in emergency rooms at all 20 hospitals. Nearly all of the bed delays -- 89 percent -- occurred at Tulsa hospitals, and 215 cases in Tulsa hospitals involved waits of more than one hour.

"This is not good for the EMS system when these ambulances are held up at hospitals. It's not good for the hospital systems or the patients," said Goodloe, also associate professor in the Department of Emergency Medicine at the University of Oklahoma School of Community Medicine.

Unique situations

The initial phase of the study did not include data on bed delays at individual hospitals. Goodloe said that analysis will occur in the next month and the data will be provided to key officials at each hospital as well as the public.

He said in Tulsa, St. Francis Hospital, St. John Medical Center and Hillcrest are the hospitals with the highest number of patient transports.

Goodloe said the board will share the data with hospitals and work with them to develop solutions to bring the hours of bed delay down across the system. Left unaddressed, the problem has grown to a crisis in some urban hospitals, with six-to-eight-hour waits for ER beds, he said.

In Oklahoma, "we hope to see a significant improvement over a four-to-six-month period," he said.

Keith Veit, director of emergency and trauma services at St. John Medical Center, said although he hasn't seen the data on St. John, he believes the hospital should fare well when it comes to the number of delays. The hospital may reach 20,000 ambulance arrivals by the time the year ends, he said.

Veit said the hospital opened a minor care unit several months ago to deal with patients who are not as sick as others.

"There are people who manipulate ambulances and use them as taxicabs. We had one patient who used an EMSA ambulance 100 times," he said.

St. John is also focused on "parallel processing" of patients, or taking multiple steps at once, Veit said.

"In a real simple way you could look at it as a pit crew" in a NASCAR race, he said.

Veit said he looks forward to the chance to work with EMSA and the Medical Control Board to reduce any bed delays at St. John.

"I think we all appreciate that we need those squads back on the streets. ... These are our brothers and sisters out there, and we very much consider them part of our team."

Defining the problem

According to a recent article in the journal of the National Association of EMS Physicians, patient "delivery time" has grown dramatically in recent years. The journal article defined delivery time as the number of minutes between an ambulance crew's arrival at the hospital with a patient and transfer of the patient to care of hospital staff.

One study found delivery time grew from a median of just under 13 minutes in 2002 to almost 37 minutes in 2007.

The causes of bed delays are numerous and vary from hospital to hospital.

Some of the causes include a shortage of hospital beds, nursing staff shortages, patients with increasingly complex illnesses, patients who use the emergency room for primary care or minor issues and a shortage of services such as X-rays.

Goodloe said he is unsure why Tulsa hospitals had so many more bed delays than Oklahoma City hospitals. One possible explanation is the reduced number of available beds in Tulsa hospitals when compared to Oklahoma City, he said.

The study found that the number of bed delays peaked sharply on Wednesdays and also in March, when flu season was in full swing.

"What does concern me is this was not a bad flu season by any stretch," so the problem could worsen during a flu season where more people are infected, he said.

A reason for the peak on Wednesdays wasn't immediately clear.

Goodloe said it's crucial not to blame the emergency department professionals who are doing their best to keep up with high patient volumes. He said he does not want "to turn this into a contentious relationship between the EMS system and the hospitals."

"This is a systemwide issue. This is a great thing that we're looking at the data. You can't fix a problem until you define it."

Hospitals in the study

The study of bed delays -- time that ambulances and paramedic crews spent waiting in emergency rooms because of a lack of available beds -- was based on five months of data from eight Tulsa hospitals and 12 Oklahoma City hospitals. The data was analyzed by Jason Likens, clinical director for EMSA and Paramedics Plus. During the next month, Likens will analyze data from the study on delays at individual hospitals. That data will be provided to the Medical Control Board, key officials at each hospital and to the public when it becomes available, said Dr. Jeffrey Goodloe, medical director for the board.

Listed below are the hospitals in the EMSA study:

Eastern Division (Tulsa metro)

--Hillcrest Medical Center

--Hillcrest Hospital -- South

--Oklahoma State University Medical Center

--St. Francis Hospital

--St. Francis Hospital -- South

--St. John Medical Center -- Broken Arrow

--St. John Medical Center -- Sapulpa

--St. John Medical Center -- Tulsa

Western Division (OKC metro)

--Deaconess Hospital

--Integris Baptist Medical Center

--Integris Southwest Medical Center

--Mercy Hospital

--Midwest City Regional Hospital

--Oklahoma City Veterans Administration Medical Center

--Oklahoma Heart Hospital

--Oklahoma Heart Hospital -- South

--OU Medical Center -- Edmond

--OU Medical Center -- Presbyterian Tower

--OU Medical Center -- Women & Children's Tower

--St. Anthony Hospital

Source: Medical Control Board

Ziva Branstetter 918-581-8306

ziva.branstetter@tulsaworld.com

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