By Jeff Horseman
The Press-Enterprise
RIVERSIDE COUNTY, Calif. — It’s not just patients who wait a while in emergency rooms.
Delays ambulances face when dropping off patients at Riverside County hospitals hurt patient care and keep paramedics from answering emergency calls, according to a new report from the county civil grand jury.
The coronavirus pandemic “did not cause this delay issue but showed the problems more clearly,” read the report issued last month.
The issue “compromises patient safety,” added the report titled “You call 911: Then What?”
Riverside County will formally respond to the report in 90 days, county spokesperson Brooke Federico said via email.
“The issue of ambulance patient offload delays is not new,” she said. “As noted in the grand jury’s report, the county has been innovative in its approach to ensure ambulances are available when they are needed. We are committed to ensuring these efforts continue.”
The report comes as the county grapples with problems affecting health care as a whole and emergency medical aid in particular. Hospitals and ambulance companies are struggling to find nurses and paramedics after COVID-19 shut down training programs and caused scores of burned-out healthcare workers to quit.
In late March, the Riverside County Board of Supervisors denied a one-year contract extension to American Medical Response, the county’s emergency ambulance provider, for failing to meet 911 response time standards.
An AMR executive told the board that his company had a hard time hiring paramedics and is taking steps — such as spending more on overtime and funding paramedic school scholarships — to fix the problem.
The jury, a court-appointed panel of 19 citizens that investigates public agencies’ inner workings and suggests improvements, toured a hospital emergency room and fire stations and interviewed county officials, paramedics, emergency medical technicians and others for its report.
Ambulances are required to stay with their patients until the hospital takes charge of their care.
Hospitals immediately treat critically ill or injured patients. But “ambulance patient offload delays,” defined as when paramedics have to wait 30 minutes or more to hand over patients, happened 38,000 times in Riverside County hospitals in 2022 — up 21% from 2019 — and delays can last hours, the report states.
Some hospitals do better than others with ambulance delays, the jury found. Those with the worst rates of meeting response time standards in 2022 included:
- Riverside Community Hospital, which met monthly response time goals 52% of the time.
- Hemet Valley Hospital (53% of the time)
- Kaiser Permanente’s Riverside Medical Center (59% of the time)
- Menifee Medical Center (61% of the time)
- Corona Regional Medical Center (62% of the time)
Riverside Community Hospital has started a plan to improve ambulance offload times, hospital spokesperson David Maxfield said via email. This includes adding 20 beds to its emergency department and a new 24-bed unit “that will help move patients out of the ER to inpatient status,” he said.
Hospitals aren’t solely responsible for ambulance offload delays, Darlene Wetton, CEO of Temecula Valley Hospital said via email.
“This is a complex issue with a wide range of contributing factors at play – many of which have plagued the entire health care system for decades,” said Wetton whose hospital is owned by the same company as Corona Regional Medical Center.
The Temecula hospital “tracks and aims to continually improve” delays and most recently met response-time benchmarks 81% of the time, Wetton added.
Allison Sundman, a Kaiser spokesperson, said via email that Kaiser understands “the importance of ambulance offload times to patient care, and we are committed to providing safe, efficient, and timely transitions from emergency medical services to our emergency department teams.”
Emergency department visits have risen annually and patients are prioritized based on the severity of a patient’s illness or injury, Sundman said.
To ease offload delays, Kaiser has added staff and is making improvements such as adding a new tower with an emergency department and ambulance bays at the Riverside Medical Center, Sundman said. These efforts have already improved offloading times, the spokesperson added.
KPC Health, which owns the Hemet and Menifee hospitals, did not respond to a request for comment.
To prevent delays, the grand jury recommended that county supervisors “review, approve, and support” delay-slashing programs. One example is a “safety net ambulance” effort in Corona in which an ambulance staffed by Corona Fire Department paramedics provides emergency service when there are no available ambulances in the area.
AMR and the county fire department should use available staff to relieve paramedics tied up with patients at hospitals so those paramedics can go back into service, the jury recommended.
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