OTTAWA -- Ottawa hospitals insist steps are being taken to free up paramedics in emergency departments, as Ottawa's new paramedic chief says level zero is "something that keeps us up at night."
Ottawa Hospital President and CEO Cameron Love, Queensway Carleton President and CEO Dr. Andrew Falconer and Montfort Hospital President and CEO Dr. Bernard Leduc appeared before the community and protective services committee on Thursday to answer questions about paramedic offload hours in hospital emergency departments.
The hospital presidents told Councillors that hospitals are creating additional bed capacity, asking for new funding for offload nurses in emergency departments and creating a new pilot project at the Civic Campus to get paramedics out on the road as quickly as possible.
According to the Ottawa Paramedic Service 2019 Annual Report, paramedics spent 53,663 hours in offload delay in Ottawa-area hospitals.
"This represents an average of 147 lost hours every day or six paramedic units from the road in hospital for the 24-hour period. These lost hours amount to a loss of 64 FTEs or approximately $7.7 million/annually," said the report.
"If offload delays continue at the rate described in this report, the Ottawa Paramedic Service will not be able to achieve the legislated response time performance standards and Council-approved targets in future years."
The Ottawa Paramedic Service Annual Report says hospital offload delays create periods where all of the city's ambulances are either on calls or waiting at a hospital to transfer patient care, leaving the service at "level zero" with no ambulances available.
Ottawa Paramedic Chief Pierre Poirier told the committee the offload delays in emergency rooms is the "single largest issue" affecting paramedic service.
"If we could find a resolve to this, this will put paramedics back on the road, this will make paramedics available to provide service to our community," said Poirier.
Poirier told the committee that level zero incidents are increasing in Ottawa, noting an offload delay drains the paramedic service of its ability to respond to calls.
"This really is something that keeps us up at night. It really is an issue that is significant to the community. When somebody calls 911, there is an expectation that there is somebody that is available to respond and provide care. This really is a significant impact on the community," said Poirier.
Falconer told the committee that approximately 85 per cent of ambulance offloads in Ottawa area hospitals are performed within 60 minutes. The other 15 per cent can sometimes wait for hours longer, which can lead to level zero.
"Level zero is an unacceptable situation for our citizens," said Dr. Falconer.
"It does frighten all of us to think that there may be times there are no paramedics available to answer those very important 911 calls."
Falconer outlined initiatives hospitals are taking to help patient flow and positively impact ambulance offload:
- Ministry funding for dedicated nurse off-load team in the emergency department
- Ambulance off-load enhancement 11 a.m. to 11 p.m. and 7 p.m. to 7 a.m.
- Additional spaces implemented to support ambulance offload
- Vertical offload to waiting room
- Renfrew and Eastern Counties Offload monitoring
- Innovative staffing models and extra staffing being hired to support emergency department flow and ambulance off-load time.
Falconer described what the "vertical offload" system is, saying "Select patients that meet certain criteria are able to get off of the ambulance stretcher, where they're horizontal and become vertical where they are standing, and then go to our waiting room where they be with others who have come in through the front door of the hospital."
The Ottawa Hospital, Montfort Hospital and the Queensway Carleton Hospital are also boosting capacity, including proactive monitoring of emergency departments and distribution of activity and implementing surge beds on inpatient units in all three hospitals. The Ottawa Hospital Civic Campus is also setting up an "ambulance intake with zero offload pilot."
Falconer told the committee that all hospitals agree level zero for paramedics is "clearly unacceptable."
"We start getting nervous when there are fewer than 15 ambulances on the street. So we're working at ways to identify early what activity we need to do at the hospital to proactively manage surges."
Love told Councillors that ambulance offload is a "significant concern" locally and across Ontario.
"The real major concern is making sure we manage the risk and making sure paramedics get to the community as quickly as possible."
Love admitted bed capacity is the major issue affecting offload times for paramedics and other hospital operations.
"When we have very good bed capacity, not only are we able to get to urgent surgery more effectively, we're able to get Pierre's team back out on the road more quickly. We're able to improve the flow through ED," said Love.
The Ottawa Hospital President and CEO said hospitals aim to have "surge capacity" beds available for the winter months to handle the increase in demand.
Councillor Carol Anne Meehan says the issue is “not new” and hospitals are “holding up (city) staff from doing their job and potentially saving lives.”
Love says the biggest concern is access to beds and the capacity at hospital. Hospitals are also looking at using nurses to take patients when beds are not available. Love says, “We will not cancel surgical procedures for patients who need that care to deploy staff. What we have to do is get more investment ramp up, so we can help Pierre get everyone on the roads. “
The hospitals are asking for more provincial funding, including an estimated $4-million to help with offloading delays.
