Yes, The ambulances are waiting outside the hospitals with the last patient so they can't go to get the next one. Source: Family members have recently waited some hours outside A&E in an ambulance.
This is hard to believe. Just wheel the patient through the front door and let the hospital do the babysitting. There is no sense in using an ambulance as a waiting room.
Babysitting? These are patients deemed medically unfit enough to bring in. Who's looking after them after they're turfed out the ambulance? Every bed in every bay in A&E is occupied, each with an allocated nursing provision.
Oh we just double the number of nurses? Yeah, but no. They don't grow on trees. The current ones don't stretch (we asked). You can't just absorb 20-40 patients into your acute departments without space and staff. The paramedics are acting as those staff, their ambulances the space. Yes it's far from optimal.
I don't really see how patients so severely ill that they need a bed in A&E with dedicated nursing provision could be discharged into community social care, though maybe I'm missing something...
About a third of beds are blocked at our local DGH by medically fit people who still require community care provision. These are people waiting to go home (or to a home) from an inpatient stay.
Until they go, A&E can't admit people through to the beds they're currently in.
Even if you lie to the population and claim you'll add 7000 beds this winter, those beds aren't staffed. We can't surge 5000 nurses and 2000 support staff out of nowhere. They're all busy.
I think perhaps their point is that, if some of the patients not discharged are consuming a nurse budget that isn’t required (because they are healthy and can be discharged), then this nurse budget could be redeployed to those waiting in admissions. Not sure how reasonable this is, I’m sure the hospitals will have thought of it themselves. But it does seem particularly silly to have the paramedics stuck in place and unable to serve anybody who may be even more critically ill.
The emergency department fills up because they can't find beds to admit people to. When the emergency department is full, there's nowhere for the ambulance patients to be put.
The patients are waiting in the ambulance because the waiting room is full, but I see your point. Why not just tip the patient onto the pavement outside the waiting room? I'm sure a full hospital with a full waiting room won't be to busy to sort that out.
> Why not just tip the patient onto the pavement outside the waiting room? I'm sure a full hospital with a full waiting room won't be to busy to sort that out.
Literally yes. Keeping them in an ambulance instead of the sidewalk won't get them into the ER any faster. And keeping the ambulance tied up at the hospital won't do any good for the next guy who has an emergency and is sitting on the sidewalk at the site of the accident either. At least if you move the injured people to the sidewalk at the hospital, the nurses can look outside and prioritize the worst. And the problem will be highly visible to the public, instead of papered over by using ambulances as waiting rooms.
What they're doing now is obviously prioritizing for appearances, not patient outcome.
Then you only rush to another patient who you can't treat either. Paramedics also need to hand off their treatment to hospital staff, if that doesn't happen then hospitals won't know what treatments were administered.
Using a parked ambulance as an ER room is gross mismanagement because the 'waiting room' for an ambulance 'ER room' is casualties spread across the entire city, such that the worst cannot be prioritized.
Even if the hospital's ER room has saturated capacity, moving all the casualties to the hospital waiting room as rapidly as possible still has utility because that allows the hospital to prioritize the worst, which they can't do if the worst is laying on the street a mile away with the ambulances all parked at the hospital.
I can promise you that the many smart people working in hospitals have considered this issue.
If someone is walking-wounded, they WILL be unloaded to sit and wait for 6 hours in a corridor.
The people who the ambulances are holding for long periods are those who are too sick to be left without attention. The paramedic staff continue to monitor them in order to escalate further if their condition deteriorates, and depending on the situation, medical staff from the hospital will be involved in this.
The ambulance staff obviously have a moral and legal duty of care, and can't just leave a seriously unwell patient on the floor outside the hospital entrance to get to the next call, which would likely be a patient no more ill than the one they just abandoned.
I’m happy that healthcare workers tend to be more empathic than what you are suggesting and will take care of patients end-to-end. You can’t load balance sick humans on the fly to achieve some optimal outcome.
