Holding ambulances is almost always an unnecessary and dysfunctional response to hospital boarding and ED overcrowding that has tragically become normalized. EMS represents a shared community resource that must remain available and accessible, at all times, to respond to critically ill and injured residents. We cannot allow the dysfunction of hospital boarding to consume the EMS system and flow out into the streets.
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ACEP Now: Vol 43 – No 12 – December 2024
Dr. Gautreau is clinical professor of emergency medicine, director of pre-hospital care, director of EMS Fellowship at Stanford University School of Medicine, and medical director at the San Jose Fire Department.
Dr. Kazan is assistant clinical professor of emergency medicine at the David Geffen School of Medicine at UCLA, Charles Drew University, and medical director at the Los Angeles County Fire Department.
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One Response to “Strategies to Reduce Ambulance Patient Offload Delays”
January 8, 2025
EvUnfortunately, in many hospitals we’ve already exhausted all of those options and still getting overwhelmed with ambulance traffic. I work in a 30 bed ED that typically has 20+ boarded inpatients and still receiving 30+ ambulances on a typical night shift. We already utilize most of these strategies (other than waiting room/triage MD/PA as we don’t have the staffing to add that as an extra shift). No option to go on divert as the nearest alternate ED is 2 hours away. Lots of pressure from hospital leadership and above to get the ambulances offloaded, so often a CTAS 3 who arrived by ambulance 2 hours ago will get roomed prior to a CTAS 2 who has been in the waiting room for 6-8 hours. Sometimes we’ll even take over the ambulatory care clinic behind the ED to house admitted inpatients at night so we have space to see ED patients, but we have to vacate by morning.
To me another solution that needs to be included is that the entire hospital shares the burden. More patients need to be boarded in hallways upstairs so that the ED can still function. Ten inpatient ward nurses having to take one extra patient each is certainly safer than and the ED nurses having to carry 4-5 inpatients in addition to taking care of a full load of ED patients who are being stuffed into every nook, cranny, and broom closet in the ED.