‘Fit-to-sit’ program introduced at Groves in response to ambulance offload delays

WELLINGTON COUNTY – A new “Fit-to-Sit” program implemented at Groves Memorial Community Hospital in Aboyne on Nov. 24 may help with a lack of available ambulances to respond to urgent and emergent calls in Wellington County and Guelph.

Using a set of medical criteria, eligible patients who are transported to hospital by paramedics are quickly offloaded and directed to sit in the hospital waiting room, rather than on a stretcher.

The program establishes “a consistent process for paramedics to move patients to the waiting room” and returns crews back to the road faster, Guelph-Wellington Paramedic Services (GWPS) deputy chief Leanne Swantko told the Advertiser by phone.

Paramedics traditionally need to wait with their patient until a verbal transfer-of-care with a triage nurse can happen.

Depending on how busy staff are, the number of crews already waiting to offload patients, and emergency department capacity, what should be an efficient hand-off can drag out across entire shifts.

Using GWPS data, the Advertiser previously reported paramedics spent 7,400 hours waiting around for a bed to free in the Guelph General Hospital (GGH) emergency department between Jan. 2021 and April 2022 – the equivalent of 616 12-hour shifts.

With Fit-to-Sit, paramedics simply hand over a written transfer form to a triage nurse, and take whatever call is next in the queue.

Crews spend about five minutes offloading a patient, according to Swantko.

Compared to offload delays lasting over 87 minutes the Advertiser has previously reported on, the program can save time and potentially help address “code red” scenarios.

“Those are times when we have no ambulances available,” Swantko said.

The province dispatches the closest ambulance to calls, regardless of what service the ambulance belongs to, but as local crews wait on offload delays, ambulances are having to be dispatched from farther and farther away, leading to increased response times and reduced resources elsewhere.

Increasing call volumes and lengthy offload delays have culminated in 50 code red events this year, where no local paramedics were available to respond to incoming 911 calls.

For someone having a heart attack, minutes may determine life or death.

Swantko says the Fit-to-Sit program has seen previous success at GGH before being expanded to Groves.

Patients are assessed for eligibility by paramedics and among other criteria must be able to walk, be mentally alert, be of a certain age, and have stable vital signs.

“There are some patients, absolutely, that don’t fit,” Swantko said.

Nurses are also able to dispute a paramedic’s decision to send a patient to the waiting room on the transfer form, for review by GWPS.

Since the program’s November 2020 inception at GGH, Swantko says “roughly 200 patients” were diverted to the waiting room there.

That number could have been higher, however previous criteria excluded patients who had been treated with rudimentary drugs such as Tylenol and Advil.

That changed as of June, and diversions are expected to increase as a result of loosened criteria.

In June, 31 people were diverted from stretchers to the waiting room at GGH, according to Swantko.

Though Groves doesn’t experience the same level of offload delays as GGH, Swantko says crews have been stuck at the Centre Wellington hospital unable to offload patients.

Kate Kobbes, vice president of clinical services at Groves, said anecdotally, the number of patients coming to the emergency department is up.

Lower acuity patients have been offloaded to chairs in the emergency department prior to the program, but Kobbes said it hasn’t “been a practice to send [ambulance] patients into the waiting room.”

Fit-to-Sit, she said, is a “deliberate” change and a “positive step in helping us manage these high volumes.”

Kobbes was unable to say how many patients are likely to fit waiting room criteria.

The paramedic service tracks each patient being sent to waiting rooms through Fit-to-Sit, with a patient’s condition, treatments and chief complaint being logged. Data is used to track the program’s use and improve on processes.

“In a nutshell,” Swantko said, those who have no complaints at all, are generally unwell, have soft tissue injuries, or minor muscle and bone injuries are being offloaded to the waiting room.