May 11--For years Marion County Fire Rescue paramedics complained about having to wait -- often for hours -- at hospitals before they could hand over their patients and get back in service.
The wait, often called "wall time," was necessary because they had to monitor their patients until the hospital staff could take over. While the personnel waited, their territory had to be covered by other ambulance stations.
The wall time, euphemistically meant to describe paramedics leaning against the wall waiting for a nurse or doctor, was becoming so prevalent that county government prepared a preliminary ordinance that would allow the county to charge the hospitals for tying up its ambulance crews.
But it might not come to that. During a workshop this week, Marion County Fire Rescue Chief Paul Nevels reported that wall time -- at least the longest stretches -- are dropping now that the hospitals have implemented a variety of programs.
After hearing that, the County Commission held off on the ordinance, but warned it could change its mind if improvement didn't continue.
"We're all trying to work on this together and I appreciate the steps that have been taken," said commission Chairwoman Kathy Bryant.
During April, there were a combined 714 incidents of delays in handing over patients to staff at Munroe Regional Medical Center, Ocala Regional Medical and West Marion Community Hospital, according to Marion County Fire Rescue records. The county considers a wait of more than 20 minutes to be a delay.
Of those 714, 309 had delays of 20-30 minutes; 238 were 31-60 minutes, and 167 were more than an hour.
While both Munroe and Ocala Regional still haven't solved their wall time problem, new programs and expansions have managed to reduce the incidents of hour-plus wall times.
In March there were 1,366 cases of delays. In April that fell to 714, a 52 percent reduction. That reduction is typically due to residents moving out of the county to homes up north. The delays greater than 60 minutes fell 70 percent, Marion County Fire Rescue Division Chief Rodney Mascho told commissioners.
Ocala Regional's bed delays of 60 minutes or more dropped 76 percent.
But despite the improvement, "there are quite a few (delays) that are over the hour mark and hitting the three, four, five and six hours," Mascho said.
Delays are typically caused by one of two problems: The hospital's emergency department doesn't have the staff to treat all of the patients arriving by ambulance, or the hospital doesn't have the patient rooms and staffing upstairs to send ER patients to make room for new ER patients. Sometimes it's a combination of both.
Munroe CEO Bob Moore said his problem was that he didn't have enough nurses to staff all his hospital rooms. Although his hospital has 421 beds, until recently he only had enough staff to handle 350.
"Ours has been a staffing problem. It hasn't been a capacity problem. We have the capacity. We're now fixing the staffing," Moore said.
Moore said that during the past two years he had more than 280 registered nurse vacancies. It is now down to 60. The hospital's typical vacancy rate is between 40 and 50.
The hospital is operated by Community Health Systems. It started leasing the county-owned hospital two years ago.
Moore said he is hiring and training record numbers of nurses. Assuming those nurses now getting orientation training stay at Munroe, Moore said, the hospital will be prepared for September, when snowbirds come back to the county. The hospital also hired its own paramedics to accept patients from the county's emergency workers and organized its staff better to improve ER efficiency, Moore said.
The hospitals are also again hiring licensed practical nurses to fill the RN void, Moore said.
In addition, the hospital is also working to assign beds to patients as soon as paramedics call in to let the hospital know they are on their way with a patient.
"As we continue to work on these changes we'll get this issue solved," Moore said.
Ocala Regional has 200 beds. West Marion has 94. Both are Ocala Health facilities, a division of Hospital Corporation of America. Randy McVay is the CEO of Ocala Health.
McVay told the commission his problem isn't staffing but capacity. In some cases, there just isn't enough room for patients.
To help fix that problem, Ocala Health is building a free-standing ER in Summerfield. The hospital also will transfer its patients to sister facilities to make room for more ill patients, or even to other HCA hospitals outside the county if patients and their families are willing, he said. West Marion is also building a new wing that will include 36 more patient rooms.
When the proposed ordinance was raised, Moore said: "If you look at the numbers, it's working ... . But we need a little more time."
Commissioners, with Commissioner Carl Zalak absent from the workshop, agreed to hold off charging the hospitals for the delays, but wants to continue to see improvements. Bryant will also meet with hospital officials each month to pore over the data.
But the decision to hold off wasn't made without first discussing other options.
"That's coming out of the county's budget," Commissioner Earl Arnett said of paramedics waiting at hospitals. "We have to implement something. We can't afford to continue paying this much money."
Fire Rescue officials at the meeting did not know the cost of excess wall time. Originally, when the county considered charging for bed delays, Bryant said hospitals had asked that they be fined only after the paramedics had been at the hospitals two hours or longer.
Commissioner David Moore said that the best way to make the hospitals solve the problem was to "smack them in the pocketbook." He said similar methods had worked in Alachua County.
Commissioner Stan McClain said the commission should hold off and implement fines later if need be.
"I'd much rather try to work with them than be in an adversarial relationship," he said. "It's about solving a problem. It's not about whacking someone over the head."
Danny Garcia, secretary of the Professional Firefighters of Marion County union, said the issue is complicated, and hospitals are not immune to staffing problems. He said the union's official position is that it looks for the county's senior management to work with the hospitals and resolve the problem.
But most rank-and-file emergency responders would recommend charging the hospitals now for the wall time. "That would at least motivate the hospitals to hire more staff," he said. "In some cases paramedics and EMTs are being utilized in lieu of proper staff at the hospitals."
-- Reach Fred Hiers at firstname.lastname@example.org and 352-867-4157.