City hospitals billed $60,000

Winnipeg hospitals racked up a $60,000 bill last month after more than 400 ambulances were forced to wait upwards of 90 minutes to unload patients at emergency departments.

April was the first month the Winnipeg Fire Paramedic Service billed hospitals for excessive delays that left ambulances waiting to unload patients. WFPS officials sent 414 bills to seven Winnipeg hospitals for every instance paramedics waited more than 90 minutes and charged a rate of $113 per hour.

The move is in response to reports that revealed one-third of Winnipeg ambulances are waiting to unload patients in emergency at any given time. That leaves them unable to respond to incoming 911 calls and forces other ambulances in service to be redirected from less critical calls to more urgent ones. Other times, ambulances are directed to 911 calls outside their catchment area, or fire crews with a paramedic on board respond and report whether an ambulance is needed.

WFPS Chief Jim Brennan said the fact they sent out more than 400 bills in 30 days shows how often the problem occurs. Five years ago, Brennan said, paramedics could unload patients at city hospitals and do the associated paperwork within 30 minutes.

Last year, ambulances waited an average of 61 minutes to drop patients off at Winnipeg hospitals -- a 53 per cent increase from 2005 and 31 minutes longer than the ideal.

"That's an average; some of these can take hours and hours," Brennan said. "At any given time, one-third of the fleet is tied up and unavailable for the next 911 call."

The billing project is one of the initiatives that have come out of a joint operating committee made up of City of Winnipeg and Winnipeg Regional Health Authority officials aimed at reducing ambulance off-load times.

It is modelled after a similar one in British Columbia, where ambulance unload times were slashed by one-third once paramedics billed hospitals for delays. By October, Winnipeg hospitals will pay a fee for ambulances waiting longer than 60 minutes and that threshold will drop to 30 minutes in April 2012.

WRHA spokeswoman Heidi Graham said city hospitals and ambulances have both seen an increase in patient volumes over the last few years. If a patient needing more urgent care is being seen by an emergency-room doctor, Graham said, that's one reason why paramedics could be left waiting to unload.

Paramedics cannot drop off a patient until that person has been seen by a doctor, she said.

Graham said the WRHA is working to reduce the amount of time ambulances are tied up at emergency rooms. When more than one ambulance is waiting, Graham said, one crew can now unload their patient to the other crew so one ambulance can get back on the road. Respiratory therapists can take over an ambulance's patient during the day before they are seen by the ER doctor, and Graham said the WRHA is drafting a new policy that would allow some ambulance patients to sit in the waiting room if a triage nurse decides it is safe.

Graham said the health authority has also provided funding to the Main Street Project so a paramedic can be stationed there 24/7. People detained for being intoxicated can be taken to the Main Street Project to be assessed for minor injuries by a paramedic instead of being transported to an emergency room. "I think it's been very successful in talking with them and saying, 'What do you think would help reduce these off-loading times?' so we can work together," Graham said.

Brennan said charging hospitals a fee is not about the money, but "getting the attention" of hospital officials. While the goal is to eventually get unload times under 30 minutes, Brennan said, the city's paramedic service could potentially use the additional money to hire more staff.

"We sent out over 400 bills, so that's the number of times last month alone this has happened," he said. "You look at it and realize the volume of these events."

jen.skerritt@freepress.mb.ca

Republished from the Winnipeg Free Press print edition May 21, 2011 B1