How long does it take you to clear the hospital?

[tskstorm]

I don't know what the issue is in charting en route. Most of my assessment is done and interventions complete before we even begin transport. Our charting system is very basic and designed to be quick as it is. On critical cases I may only enter demographics or nothing at all. I know what its like to be "in the hole" with multiple charts and its not ideal.

If you enter demographics or nothing at all, how do you bill, how do you do Qa/Qi, what about continuity of care?

How does the hospital have a clue what you did ?

This is a load of nonsense. I often arrive at the hospital with a blank ACR/PCR and simply remembering vitals and critical information to give in my report to the nurse/doc. and at the conclusion of my patient care then find a corner to write in, and write out an entire ACR/PCR with what information has been available to us. Even to the extent of getting demographics or billing information from the hospitals. Before I leave that hospital before I can take another assignment the ACR/PCR must be complete with a copy given to the hospital. Most Rn's after they become familiar with the individual completing the ACR will sign it unfilled out, and just require you to drop it off when done, but when going to a facility you don't frequent often, or meeting a new RN they will not even sign the receipt of patient/transfer of care until your PCR is complete.

This goes for ALS and BLS, from the chronic ETOH frequent flier, to the traumatic arrest. As Richard stated we will have supervisors dispatched to our locations if we're taking too long but sometimes you are going into the hospital with nothing written in, and it takes time to get your information and organize it and properly document everything and their are other times where you are the 8th, 9th or 10th ambulance in line to be triaged. You can't expect to be triaged, in 10 minutes.

[46Young]

I forgot to mention another important point - if the agency pulls units from the ED prematurely for calls as a rule, then they're misrepresenting the adequacy of their staffing and # of units in service, as well as response times. A unit isn't clear from the ED until their report is complete. The main intent of the prehospital PCR is to provide info on pt care, to facilitate transfer of care in conjunction with a verbal report. If your report isn't delivered to the ED staff in a timely fashion, as in before you go inservice, then pt transfer isn't truly complete, even though your blank form/tablet is signed.

Many agencies refuse to upstaff their units, preferring instead to put units back in service to cover pending calls. This is an artificial way to increase coverage and response times. An EMS unit ought to be handling only one call at a time, but are in fact handling multiple, since their previous ones weren't finalized in regards to documentation. Instead of adequately upstaffing, they keep their existing units running constantly without regard to pt transfer obligations. When the bean counters look at the stats, they show adequate coverage and good response times. Good luck with ever having decent staffing levels and adequate units inservice.

Tskstorm, one thing that freaked me out after I left NY was that whenever we arrived at the ED we immediately, with very few exceptions, were given a room with an ED tech and RN promptly assuming pt care. I've been backed up 7-8 deep at Elmhurst or Booth with an hour wait more times than I care to remember. It's freaky when you get a room with no wait, and a staff doing their own triage right away. Some ED's have supplied coffee makers, granola bars and other assorted snacks, Gatorade, hot cocoa, it's sweet (pardon the pun).

Edited January 2, 2010 by 46Young

[EMS49393]

I don't know what the issue is in charting en route. Most of my assessment is done and interventions complete before we even begin transport. Our charting system is very basic and designed to be quick as it is. On critical cases I may only enter demographics or nothing at all. I know what its like to be "in the hole" with multiple charts and its not ideal.

You believe it's more important to sit there and write a chart than to interact and reassess your patient? The patient is why we are there. The charting is a necessary evil, and it can be completed after you take care of the patient.

I've worked in a large urban system where I ran more than 14 calls in a 12 hour shift, and I didn't hardly chart a thing outside of basic information and pertinent findings while I was with the patient. I bet your patients feel all warm and fuzzy that you'd rather sit and do a report than interact with them.

[Dustdevil]

This is really two separate questions:

1. How long until your unit is available for the next run.

2. How long until you actually clear the hospital.

It should rarely take any more than fifteen minutes to make your unit available for the next run. It is the driver's job to IMMEDIATELY take the cot back to the ambulance, clean it and the ambulance, replace linen, restock supplies, and notify dispatch that we are available, but still out at the ER pending paperwork. The driver shouldn't be dicking around in the ER, flirting with nurses, gawking at patients, eating and drinking snacks, smoking fags, or just generally being useless until AFTER the unit is ready for the next run.

In my experience, the problem is usually that the driver fiddle-farts around forever before returning to the truck to ready it.

As for actually returning to the street, it takes as long as it takes. If there is opportunity to do so without neglecting my patient, I will do some basic charting enroute. Mostly, I only get demographic info during the trip, as well as charting vitals and other immediate concerns. The narrative will all be done at the hospital when I can concentrate solely upon it, with all information finally available. That usually takes no more than thirty minutes max, and unless a priority run comes in, will always be completed before leaving the hospital.

Of course, if you're using the lame-arse charting system (whether electronic or hardcopy) that is a simple system of box-checking and drop down answers, then this should all be happening in about half the time of a narrative. In that case, the medic should be ready at about the same time as the driver, unless there are unusual complications.

[CBEMT]

If you enter demographics or nothing at all, how do you bill, how do you do Qa/Qi, what about continuity of care?

How does the hospital have a clue what you did ?

This is a load of nonsense.

Umm, decaf maybe?

Pretty sure he was talking about demographics being the only thing he writes down EN ROUTE. Not "at all." Since that's what the last few posts were about- documenting en route versus waiting.

Edited January 2, 2010 by CBEMT

[kohlerrf]

We run a Paramedic and an EMT-I on every ambulance. We split the duties based on weather it is an ALS or BLS Patient. In route to the hospital we call in to advise what we have, on arrival the ER staff is pretty good about having a bed assignment for us. Once the pt is off our stretcher and a verbal report is given to the nurse or doctor we are available! Documentation can wait but must be submitted in a timely manner and definitely before the end of the shift. Generally we are available 5 min after arriving at the hospital. There are those occasions where you have to decon the ambulance due to blood or other substance or you are critically low on supplies but by in large we are considered to always be in service, as a matter of fact, normally the dispatch center never puts us out, if another job comes up in our area they will dispatch us and if we are out of service and cant take the call we tell them to dispatch another unit....and then get on the phone with the supervisor if you know what I mean....I guess we do pretty much the same thing as "Grumpy Old Man"

Edited January 3, 2010 by kohlerrf

[fiznat]

I agree with others that have questioned the practice of leaving the ED without first finishing the paperwork. I like to think that our documentation is an essential link in the chain of emergency care, and to allow submission of it as much as 10 or 20 hours later really undermines that purpose.

As I said earlier, I am lucky enough to work in a service that prescribes to the "we are clear when we are clear" philosophy. Our medical control actually specifically states that we CANNOT clear from the hospital without leaving paperwork for "trauma alert" patients. I'm not sure why only significant trauma patients are specified in this rule, but it is a good example of a system that places a high value on the role of EMS in continuum of patient care. Even if our supervisors get involved in trying to get units clear from a hospital, there is a (mostly) unwritten rule that patient care comes first - regardless of who wants corners cut at that particular point in time.

I complain a lot about where I work, haha, but this is something I think we do right. ...Let dispatch whine all they like.

[Richard B the EMT]

Seems that most of us that are sent a supervisor after a period of time, usually get one more for "clearing a path" for us, when the problems are not on the part of the team from the ambulance.

Also, as long as the supervisor is there, whether the hospital requests it or not, can verify the need to divert to either specific categories or all at that ER, even if it is only for 2 hours or so.

(Again, the next ER is usually 20 or so minutes away, which I have mentioned many times, is NOT a luxury enjoyed by some services. This is not taking specialty categories, like Trauma or Burn into consideration, and any patient in "Extremis" goes to the nearest ER anyway)

[firemedic37]

Times vary greatly depending upon what type of call and which hospital I transport to. Some hospitals push you out faster than you can give a good report while others invite you to see your Acute MI pt go into the Cath Lab. I am sure it is like this everywhere, an average time for BLS calls is 5 - 10 minutes and ALS 10 - 20 minutes and no I do not write the report in the ED.

[46Young]

Seems that most of us that are sent a supervisor after a period of time, usually get one more for "clearing a path" for us, when the problems are not on the part of the team from the ambulance.

Also, as long as the supervisor is there, whether the hospital requests it or not, can verify the need to divert to either specific categories or all at that ER, even if it is only for 2 hours or so.

(Again, the next ER is usually 20 or so minutes away, which I have mentioned many times, is NOT a luxury enjoyed by some services. This is not taking specialty categories, like Trauma or Burn into consideration, and any patient in "Extremis" goes to the nearest ER anyway)

Speaking of specialties, I understand that Jamaica Hosp is a post arrest cooling center. What other hospitals have this designation?

A friend of mine worked an arrest at Parker Jewish on the LIJ campus, achieved ROSC, and was mandated due to protocol to txp across the borough to Jamaica, maybe a 20-30 minute trip unless the highway is clear, then maybe 10. Does this make any sense?

*For those without knowledge of Queens, Parker Jewish, a SNF/rehab facility is owned by and on the same grounds as LIJ hospital, on the border of Nassau County and Queens County, off exit 25 on the GCP and exit 33 on the LIE. Jamaica Hosp is off of the Van Wyck Expwy, much deeper in Queens, and can be an extended trip with traffic.*

Edited January 4, 2010 by 46Young