How long does it take you to clear the hospital?

[FredG]

For us, BLS - it takes 10-15 minutes for most calls to clear the local ED. After pt is transferred to their bed, the EMT completes the PCR and the driver cleans/restocks as needed.

The next county over is under a different REMAC. They are all electronic and clear as soon as possible. They have 3 hours to close out the report on EMSCharts, which then triggers the fax to the ED. The REMAC sends out monthly compliance reports with closure rate of ePCRs within the 3 hour window.

[Richard B the EMT]

FDNY EMS Command, and other ambulances in the NYC 9-1-1 system are allowed 20 minutes from arrival at an ER to clear, otherwise, they have to contact EMD with a signal update, like extended: 1) cleaning up the ambulance, 2) awaiting an ER bed, 3) awaiting the patient being triaged, 4) paperwork, or 5) waiting on the triage Nurse signing the PCR.

If we go another 20, we contact again, and if we feel it necessary, request the supervisor to help get things moving. If we end up with yet another 20, the supervisor is supposed to self dispatch to find out the conditions causing the delay.

Policy calls for the part of the PCR that goes to the ER admissions clerk be completed, and signed by the Triage Nurse before being turned in.

[stcommodore]

Since we had our scheudled distaster called "new years eve night" yeasterday things ran a little different and almost better. Typically at night we have about 28 ALS/BLS squads in service and at times can run out of squads on a busy night. In NYE's past people died waiting for a squad and the bad press has led the powers that be to staff all 50 squads for the night now. In addition to that we had our ems batallion chief in the communications center keeping people from hiding out at the hospitals for to long. Needless to say when you have enough units to meet the demand it makes the night go better.

In my part time suburban job where we are just starting to get MDT's that allow us to see our runs via computer it still takes alot longer to totally complete a call because of paper charting. The call volume isn't as high and money isn't as abundent so things are different. But obviously echarting, dispatching, interface between those two, as well as uploading EKG to the computer (which I can't get to work, ugh) makes life so much easier.

[CBEMT]

We usual have like 70% of it filled out by the time we get to the hospital. My state doesnt take EMTs serious at all though. Our verbal reports end up being very short as the nurses just blow us off. This could have something to do with how quickly we get out of the hospital.

Or- don't shoot the messenger- it could have something to do with the fact that they know you spent more time with your paperwork than the patient. Sounds like you work at a private. Guess how many competent EMTs working at privates the triage nurse has seen in his or here time?

I'll give you a hint- it's very likely a small, small number. You could be the best EMT at your company, but if one of your colleges was a moron earlier that day, the nurses are probably going to treat you the same as they'll treat him. Guilt by association. It sucks, but that's life.

Just some advice from me to you.

As far as the original question, it takes us whatever it takes us. We restock from the ER, including meds. If it takes the supply guy a while to get to us, and it takes me awhile to find a nurse with enough free time to resupply my meds, I could be there 45 minutes sometimes. And that doesn't always include report time (I tend to write more than most people I see). We're required to leave a completed run report copy before leaving, so no matter what dispatch wants, I can't leave until at least then.

Nowhere I work has a set policy. One dispatch might start calling if they're busy and running out of trucks in service, or if they have another one for us. They can't order me to clear, but the supervisors might become more interested if I make a habit of very long OOS times.

[EMS49393]

It takes me an average of 30 minutes to clear the hospital, and that's without writing a PCR. We have some trouble getting rooms, unless the patient is critical, even more trouble getting a nurse to transfer care, and we have to register the patient before we leave. If it's shift change, it's even longer. Sometimes I'm super lucky and get to make a stretcher after I treat the patient, wait to transfer care, and get them registered. We have a few social butterflies at our company and making beds is just not high on their priority list. I generally have any other mess I've made cleaned up well before we reach the ER.

As for the PCR, we use an internet program, so we don't actually even begin the report until we return to the station. The state gives us 24 hours to complete a report. Once completed, the report is faxed to the hospital. I don't really agree with this, but sometimes you have to pick your battles. Our PCR for an ALS provider can take anywhere from 45 minutes to several hours to complete. It's not my favorite program.

I'm not sure how the BLS guys do for time, but I'd venture to guess they get finished a lot faster than we do.

[stcommodore]

My cut off for waiting for a bed without starting to complain comes when I finish my chart and am still sitting with the patient on my stretcher. Which ment that its actually a patient in need of a bed and I just using the onscreen keyboard chicken pecked out an entire narritive.

When it comes to "stocking from the hospital" I think the places that have to do "hunt and steal" supplies

a)don't have a high enough call volume that hospital turn over time is important

b)don't have the money or want to spend the money to supply themselves

[CBEMT]

When it comes to "stocking from the hospital" I think the places that have to do "hunt and steal" supplies

a)don't have a high enough call volume that hospital turn over time is important

b)don't have the money or want to spend the money to supply themselves

We don't "hunt and steal."

State law requires them to resupply us.

Now. If you ask why that law was enacted.... I have a few theories.

[46Young]

My experience in NYC was the same as how Richard B described it.

For Charleston County EMS, you're considered clear the moment you show at the hospital. It's not uncommon to have the next call show up on your screen before you unload your pt from the bus. They have ePCR's with Zoll interface, so all the ED gets initially is vitals and ECG's. There is a 24 hour requirement to fax the completed report to the hosp. It's absolutely miserable to play catch up with four or five half finished reports at 0200 hours, or even at the station computer after your shift has ended.

Fairfax County FRD won't dispatch you for another until you give the available signal, which is after the report is completed in it's entirety. We have Toughbook ePCR's like CCEMS. We also believe that we shouldn't be entering info into the ePCR while actively engaged in pt care. If you have an intern in the back with you, or are still onscene with other medics working the pt, then you may get a few things entered, but that's it. Typical ALS turnaround times in the County average 30-45 minutes, unless it's a complicated call with many interventions or an arrest, which naturally require more carefully documented, more extensive reports.

I have a few thoughts about writing reports during pt care and being forced to clear the ED prior to PCR completion:

CCEMS officially says that you shouldn't enter info during pt care, but it's unofficially encouraged (mandated even) that you get as much documented as possible, since it's highly likely that you'll be forced out of the ED prior to completion of the PCR. This obviously results in poor pt care if you're the sole provider riding in the back with the pt. There are many questionable unwritten rules at that place.

If a crew has to play a constant game of documentation catch up with several reports during their shift, it becomes increasingly difficult as the day goes on to accurately document each report. You have maybe four or five reports with varying degrees of completion. It can be challenging to remember the details and pt interview from a few calls in the morning when it's now eight or ten hours later. This policy greatly increases the likelihood of inaccurate or even fabricated documentation, IMO and from personal observations.

If it's policy to have crews be made available and handle calls without completing reports, then how important is it really to have a run documented by the crew? By making it policy to allow the crew to leave the ED with an unfinished document, only a verbal report to the ED staff, the agency is saying that PCR documentation is not necessary for the ED to treat the pt. Think about it - if you have 24 hours to complete and fax a report (or even 3 hours as some agencies require), the PCR is largely irrelevant to in hospital pt care at that point. the only importance the PCR holds at that point are billing, QA/QI and maybe some potential medicolegal issues.

Subjecting crews to the constant game of PCR catch up throughout the shift, and into the overnight, only adds to burnout poor job satisfaction, and attrition.

Edited January 2, 2010 by 46Young

[stcommodore]

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.

[scott33]

About 10 - 15 minutes