Long ambulance wait times an indication of bigger health care problem: Nova Scotia physician

A leading emergency physician with Nova Scotia Health says long ambulance wait times aren’t indicative of emergency department issues, but speak to a larger, more complex issue with patient flow and hospital capacity.

Earlier this week, the Nova Scotia NDP released details from a freedom of information request that showed 16 of the province’s 38 hospitals had an average offload wait time well above the 20-minute recommended time frame for ambulances to discharge patients.

The numbers varied across the province, but the Halifax Infirmary, the largest and busiest hospital in the province, on average sees paramedics spend 95 minutes waiting to offload patients.

Dr. Todd Howlett, an emergency physician and Nova Scotia health’s executive medical director for the Central Zone, is in charge of patient flow at all hospitals in that zone.

“It’s hard to talk about averages,” said Howlett. “The impact for us is we clearly want paramedics out of the emergency department and back on the streets to do what they need to do.”

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The Halifax Infirmary sees on average around 50 ambulances arrive per day, but improving ambulance wait times doesn’t just fall into the hands of the emergency department. It speaks to more complex issues that many hospitals face, said Howlett, like overcrowding and a lack of available beds.

“We need to lean in and figure out a way for people that don’t need the hospital to be cared for in another setting,” said Howlett.

“We still have scenarios where we have people, for reasons of care, they remain in the hospital because they can’t be cared for in other scenarios.”

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It’s bigger than a lack of long-term care beds, Howlett says. On any given day he believes the hospital is caring for 100 patients who would who could be receiving treatment in another setting.

In early March, the province released the Fitch Report, a 118-page document that the government requested to look into the state of the emergency services and ambulance wait times.

A report into Nova Scotia’s privately-operated ambulance service says a significant amount of ambulance time is exhausted by unproductive non-emergency activities.

The report produced 68 recommendations on improving ambulance services. Many have been implemented already, but Howlett says the best solution might be around transportation and no longer using ambulances for routine patient transfers and for patients already in more stable conditions.

Nova Scotia’s minister of health and wellness, Zach Churchill, said the province has hired 21 more paramedics to help address the strain on the system. He also issued a ministerial order on March 8th, directing Nova Scotia Health to improve off-load times, with a target of 30 minutes.

In the meantime, Howlett says health-care experts have learned a lot during the pandemic and when it comes to patient flow, they see opportunities to improve that through using more streamlined communication technologies.

“We still talk when we’re on mute occasionally,” said Howlett. “But the technology has allowed us a new level of interconnectedness, it’s brought the whole province together.”