Board OKs investigation into patient offloading problems countywide

The Board of Supervisors today unanimously approved assigning a standing committee to research and find potential solutions to the "significant and detrimentally impactful" problem of delays at hospitals throughout Riverside County in accepting patients brought in by ambulance.   

New board Chairman Jeff Hewitt and Supervisor Kevin Jeffries will proceed, as members of the Fire Ad-Hoc Committee, to investigate why the practice of patient offloading is faltering and how it might be remedied.

Staff from the county Emergency Management Department presented data showing a 110% increase in recent weeks in patient offload delays at hospitals, which officials acknowledged had been influenced by coronavirus cases, but the trend line has been pointing up for years.

"Paramedic first responders are forced to wait for extended periods of time," EMD spokesman Trevor Douville told the board. "Since 2015, we have seen progressive and cumulative increases, and the worsening patient offload delays have impacted first responders."

EMD Director Bruce Barton said that even after COVID-19 "comes down ... this problem will still be here."  

"We need resolve, and that frames the environment of what we need to get something done," Barton said.  

According to a statement posted to the board's agenda by Hewitt and Jeffries, "patients having to remain on the ambulance gurney for several hours after arrival at the hospital is now commonplace."  

The supervisors said the county's target maximum time for a person to lay in an ambulance after arriving at a medical facility is 30 minutes.  

"We cannot fulfill our missions if this continues," county fire Chief Bill Wiser told the board. "A lot of times, we have engine (crews) responding, and there's no ambulance responding with them. We've had engines waiting two hours (with patients) for an ambulance to come to the scene."  

The ambulance delays are directly tied to offload disruptions occurring at facilities, according to the EMD.

"Some hospitals have very high volume, but they still perform very well," Douville said. "They have surge plans in place."  

Barton pointed to understaffing at hospitals as one of the impediments to efficient patient admissions at some facilities.   

Countywide delays in offloading were highlighted during the late fall of 2020 amid the coronavirus surge then underway, when hospitals were experiencing major challenges finding triage and bed space. However, the problem appears systemic and goes beyond demands related to COVID-19, officials said.  

Supervisor Karen Spiegel wondered whether the hang-up was the "new normal" statewide, and Douville said many hospitals in California had been experiencing similar troubles.

"But some of our (local) hospitals are at the top of the list," he said.  

Officials said various measures have been implemented to solve the problem, including better communication between ambulance companies' supervisors and hospital administrators, as well as the collection of weekly and monthly tracking data and reports connected to offloading that are circulated among administrators to underscore deficiencies.  

"Unfortunately, some hospitals continue to escalate ambulance patient offload delays despite the mitigation activities," the supervisors said. "The problem has never been more significant and detrimentally impactful to the emergency management system. Additional measures to mitigate the problem and ensure consistent 911 ambulance response times are required."  

The Fire Ad-Hoc Committee is expected to hold hearings in the coming months and return to the board with a report before the end of the current fiscal year.