The bottleneck in London’s two hospital emergency rooms has grown so bad so fast, that some paramedics are spending more time waiting in hospital hallways than responding to emergencies.

In the first two weeks of 2018, Victoria and University hospitals were filled with patients, data show, leaving little room for a flood of flu patients as an especially nasty influenza season swept across the region.

But even before the latest onslaught, paramedics have increasingly been stranded in hospitals.

In 2017, paramedics who are supposed to spend no more than 30 minutes each time they drop off patients at Victoria and University hospitals instead spent an extra 10,800 hours, the equivalent of losing a 24/7 ambulance crew for more than 451 days.

“When . . . ambulances are delayed at hospital, they are out of service, thereby decreasing the system’s ability to provide lifesaving support throughout Middlesex-London,” Neal Roberts, chief of Middlesex-London Paramedic Service and director of emergency services, warned in a recent report to Middlesex County council.

Instead of having 24 ambulance crews during the day and 16 at night to respond to 911 calls, too often, there are few ambulances available or none at all.

“Incidents of Code Critical coverage (when coverage is down to three available ambulances) and Code Zero coverage (no ambulances available) are becoming more frequent, which have a direct impact on patient care,” Roberts wrote.

While local paramedics borrow ambulance crews from the county and surrounding areas when most or all London paramedics are stuck at the ERs, crews are spread thin and response times can suffer, Roberts told The Free Press.

That there are lengthy delays at hospital ERs isn’t new — such delays were one of the reasons London Health Sciences Centre (LHSC) embarked four years ago on an ambitious project to streamline care, borrowing methods made popular by giant automaker Toyota.

In fact, those behind the Toyota changes said they might reduce delays for paramedics, and even suggested early on that the

changes were having their intended effect.

“It is possible that (the Toyota changes) may have (reduced) off-load times,” Dr. Adam Dukelow, the chief of emergency medicine, wrote in a preliminary study published last April.

“Off-load times are one of many outcomes we aim to improve.”

But instead of improvement, the opposite occurred: Delays for paramedics have more than doubled since 2015, including a 45 per cent jump from 2016 to 2017, data from paramedics shows.

“It’s a massive increase,” Roberts said.

It’s not unusual to find seven or eight ambulance crews stuck at each of the city’s two ERs, Deputy Chief Al Hunt said.

Faced with ER woes and overcrowded wards, London hospital brass frequently say problems here reflect what’s happening in hospitals across Ontario, a refrain Dukelow repeated Wednesday.

“We do our best to get patients off of stretchers,” he said, praising the work of ER staff faced with daunting challenges, including increasing demands by patients who must wait long times to be assigned a room in chronically overcrowded hospital wards.

The needs in the ER are so great, “occasionally” managers re-assign an offload nurse to work elsewhere, such as to help with a trauma, he said.

But it’s not an occasional occurrence, local paramedics say — it happens with regularity. When it comes to offload delays, paramedics in London say our city’s hospitals have played a unique role making a bad situation worse.

Since 2008, Ontario’s Health Ministry has provided funding to hospitals to assign nurses to focus only on taking over the care of patients brought there by ambulance — that way, paramedics can be freed up more quickly to return to the road.

Other hospitals have made full use of that funding and sometimes even added to it, Roberts said.

But LHSC appears to be alone in directing offload nurses to instead return to the ER.

In the budget year ending last March 31, the hospital yanked offload nurses so often from shifts that are supposed to be covered daily from 7 a.m. to 11 pm, the hospital had to return $170,000 to the provincial government. From April to September of 2017, that practice stripped offload nurses of 1,739 hours, and if that pace continues this budget year, the hospital would have to return $206,000 to the province.

“Almost daily, the LHSC (ERs) are short staffed, which ultimately results in LHSC pulling the Dedicated Offload Nurse as well as closing patient care beds and/or pods within the ED. Paramedics are used to support patient care while sitting for hours on end in the hallways in the ED,” Roberts wrote.

The growing delays prompted county politicians to seek meetings with LHSC’s chief executive and the agency that oversees health care spending in the region, the South West Local Health Integration Network, Roberts said.

The crisis would have peaked the first few weeks this year, as the number of flu cases spiked in what’s expected to be an especially bad season for influenza, but paramedics planned for that by adding two or three extra crews each shift, and LHSC has done better not pulling so many offload nurses from their assigned work, Roberts said.

The crisis not only affects patients but also taxpayers – more than $1.5 million in lost paramedic coverage and extra costs for items such as overtime and extra staffing.

“Middlesex-London Paramedic Service Senior Management have met with LHSC Senior Management on numerous occasions to discuss these issues and work on solutions, but offload delays continue to escalate in the face of increasing (ER) patient volumes,” Roberts wrote in the report to Middlesex politicians.

jsher@postmedia.com

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OFFLOAD HOURS

(Any time greater than 30 minutes spent by a paramedic crew at the hospital ER is considered an offload delay)

2013 - 5,921

2014 - 6,019.

2015 - 5,017

2016 - 7,437

2017 - 10,800+*

*Preliminary figure still being finalized

BED OCCUPANCY LEVELS

At University and Victoria hospitals, and the latter’s psychiatric ward, as the percentage of funded capacity