What's the longest you've had to wait to transfer a patient to a busy hospital?

Recently, two paramedics in England had to wait two hours. Read the story here:

http://www.jems.com/article/news/paramedics-wait-2-hours-transfer-p...

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I think that this practice is horrible but now more common place where I work. Prior to a couple years ago it was not uncommon on a 12 hour shift to be waiting wit patients in the hallway for at least up to 25-30% of the shift. The longest I ever waited was almost 5 hours and that was with 3 patients that I was looking after. At one point in time the hallway wait times for our crews got so bad that they placed 2 paramedics in the hallway that their sole job was to take patients from field crews and stay with the patients until they could be seen in the ER. That process has gotten better but we still wait in the hallways and now have patient consolidation porotcols wereby we take each others patients to alleviate ED overcrowding by EMS crews. There are a bunch of other factors that are in place here but 3 years ago it got really bad for quite a while.

45 minutes, in a community hospital who took numerous walking patients from waiting room back into rooms while stepping around our litter...they were there  first, I was told, when I asked!!!

Coming in the back door by ambulance doesn't necessarily mean that you get seen first.

Hopefully, somebody performed triage and they were taking the more sick patients first.  And if the patient on the stretcher has been triaged, why not just send them to the waiting room?

 four and a half hours

Treliske Hospital

Cornwall

England

Our EMS service(as with most in the UK) have started charging the hospitals if the waiting time is over 15 minutes. In reality no money actually passes between companies but it is seen by the government as targets missed and leniency on performance as far as trust incentives and bonuses are concerned.

The crews are also under scrutiny if they do not go code green within15minutes from handover in the ED and questions asked with potential for disciplinary action.

Nope, pt not triaged.  Patients have to be registered before they are triaged, at that particular hospital.  The ones that were already registered prior to our arrival got triaged ahead of our patient, while we stood in the hall with the patient on the litter while the triage nurse went past us and got patients out of the waiting room.  Once, we were told to put a patient in the waiting room who had aspiration concerns and likely a fractured pelvis, PRIOR to being seen by a nurse.  Needless to say I went and got the charge nurse on THAT one.
 
Skip Kirkwood said:

Coming in the back door by ambulance doesn't necessarily mean that you get seen first.

Hopefully, somebody performed triage and they were taking the more sick patients first.  And if the patient on the stretcher has been triaged, why not just send them to the waiting room?

Backwards. Triage first, then register. Medicine before money and paperwork.

You're preaching to the choir...to be fair, things have improved a little bit in this hospital's new ER--traffic flow is better for ambulance patients.  You go to a room which is in a pod, then you have only to wait for a nurse.  Registration clerk comes to the patient.  Now I don't know how the process would work if you walked in--there might still be registration and then a wait for triage.  Hope not to find out, either...

Skip Kirkwood said:

Backwards. Triage first, then register. Medicine before money and paperwork.


Hopefully just a "mini-reg," which is basically get their name and DOB so you can get them into the computer system (and connect this visit to their medical record, if available), then go back and get financials/address/etc later. Nothing backwards about that, especially in places where triage notes go into the computer, and it's often done by registration personnel, though sometimes by nurses.

Now a FULL registration, I agree, should happen after triage. 

Around here, the medic pushes the patient on the stretcher through the door, talks with a triage nurse who does a brief evaluation, and the patient gets assigned "somewhere." THEN the registration thing happens. "Somewhere" could be any place from a room in a bay, to the stretcher triage area, to the waiting room - but it happens first. THEN the data police show up and get the mighty insurance information.

Now THAT'S the way it SHOULD be.

There's a flaw to the triage first register after system.

There is an an acceptable / unacceptable time (in the UK) that patients are expected to be in the ED - 4 hours.

If the triage time is grossly extended and only then is the patient registered then this impacts upon the actual time the patient in in the dept.

If the patient is in the dept for more than 4 hours the ED are financially penalised for failing a target.

There is a step wise approach to registration over here - basic details are taken to put the patient on the system and to get the clock ticking. 

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