San Francisco hospital overcrowding causes serious ambulance delays

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When the emergency room at Van Ness Avenue Hospital at the California Pacific Medical Center is overwhelmed with patients, nurses are often forced to lay people down on hallway beds until a room becomes available.

For some patients, this waiting in the hallway lasted up to two full days.

“We will put screens around them, but that is their only privacy,” said one of the senior nurses at the hospital, who, along with other colleagues interviewed for this article, spoke on condition of anonymity for fear of retribution.

“They’re in this hallway next to the psychiatric ward where the patients are screaming and screaming,” the head nurse said. At the same time, the light in the corridor is on all night, and patients have to use a shared bathroom.

The overcrowding is making the California Pacific Medical Center, also known as CPMC Van Ness, unsafe, a nurse on duty said, adding that there have been instances where the hospital has struggled to find a place to treat critically ill patients. According to another nurse, the emergency room is incredibly crowded several days a week.

The ripple effect of overcrowding is spreading throughout San Francisco’s emergency response system. A full hospital means that ambulance crews must wait – sometimes for hours – before transferring patients. And every ambulance that’s parked outside the hospital leaves San Francisco, and one less car that’s answering 911 calls.

“[When] we are at the limit, we have no more space,” said the nurse on duty. “So when the ambulances arrive, I try to put them to bed. But there really is nowhere to go.”

New data obtained by The Standard shows that in 2022, no hospital in San Francisco was able to complete its assigned tasks of unloading patients quickly enough to avoid interfering with the city’s first responders. Because of this, many waited too long for an ambulance to pick them up.

And nowhere was the problem more pronounced than at CPMC Van Ness. According to reports from the San Francisco Emergency Services Agency (EMSA), ambulances have been idle at Van Ness Hospital for much longer than their counterparts.

Long delays at CPMC Van Ness are a prime example of the problem hospitals in California and the rest of the country are facing, experts say. A member of the Southern California legislature recently introduced legislation to curb severe delays in emergency services.

Sutter Health, the parent organization of CPMC Van Ness, declined an interview request. In response to a detailed list of questions outlining the findings of this report, a spokesperson for Sutter Health issued a brief statement.

“As part of Sutter Health, we are partnering with local ambulance agencies and fire departments to ensure accurate data is collected on when patients are unloaded from ambulances and to identify solutions that are best for patients,” it said in a statement. “Our nurses and emergency room leaders are constantly implementing best practices to provide patients with the care they need, in the right place, inside and outside of Sutter.”

According to San Francisco’s EMSA, there were 162 cases in 2022 when CPMC Van Ness made ambulance crews wait more than two hours before taking patients into their care. While these extreme delays represent just 1.5% of the number of ambulances arriving at the hospital last year, they reflect a persistent inability to clear the queue so that paramedics can respond to new emergencies.

Under EMSA standards, hospitals must unload patients from ambulances within 20 minutes 90% of the time. Last year, CPMC Van Ness broke that standard every month. Instead, it unloaded patients within 52 minutes 90% of the time, according to the San Francisco Emergency Department’s monthly emergency hospital report, obtained by The Standard.

But are hospitals entirely to blame?

The idea that hospitals are responsible for ambulance delays is a “myth,” according to a paper published by several industry groups. The report says the bottleneck is due to the growing number of patients and burdensome transfer rules.

However, in a recent report, a group of ambulance companies, hospitals, and emergency services across the state made it clear that the problem dates back to overcrowded hospitals.

Assemblyman Freddy Rodriguez, Pamona State, worked as a lifeguard in Los Angeles County for 30 years. He remembers spending up to 12 hours before the hospital staff got rid of his patients.

Rodriguez said the lack of mandatory statewide regulation has allowed the issue to go largely unchecked. Without strict rules, local regulators can choose how to deal with a problem. This leads to endless meetings and conversations about the problem, but no real solutions.

That’s why he introduced the AB 40 last December. If passed, the bill would require the California Emergency Medical Services Agency to develop the first nationwide standard for EMS patient unloading time: 20 minutes, 90% of the time.

“If we don’t spend time on this, then guess what? It’s just pointless. Everything will continue as usual,” Rodriguez said. “Ambulances will be delayed in responding to emergency calls, and people may die due to delays in the responses of our first responders.”

The San Francisco EMSA is meeting with hospital leaders to discuss the timing of unloading ambulances, an agency spokesman said. Those conversations also included the San Francisco Fire Department, which operates most of the city’s ambulances, according to its medical director, Dr. Jeremy Lacock.

Despite efforts to set up the city’s emergency response system, delays persist across the city’s hospitals.

“Physically, there aren’t enough beds, or nurses, or paramedics,” Lacock said. “And that part is really hard to change.”

Adding more beds to the hospital is a massive and costly undertaking, Lacock said. Not only will San Francisco’s hospitals have to contend with the city’s notorious Byzantine building permit process, they’ll also have to apply for licenses for new medical beds and then find new staff at a time when facilities across the country are struggling. forces are trying to keep health care providers. payment statement.

While talk continues on how to address delays in unloading ambulances, there are no signs of the problem slowing down. According to Lacock, the need for ambulances in San Francisco is growing every year, while hospital capacity remains the same.

This is true across California: Emergency room arrivals have skyrocketed since the worst of Covid subsided, said Dr. James Dunford, who works for the California Emergency Medical Services Board and spent two decades as San Diego’s medical director.

“Hospitals are now overflowing with sick people than before,” Dunford said.

At CPMC Van Ness, one head nurse said they take a lot of pride in their work. The hospital’s specialized services, such as transplant teams, bring people from hundreds of miles for care they can’t find elsewhere. But that doesn’t solve current problems, such as overcrowding, which is preventing staff from providing the best possible care, the head nurse said.

“I know people want to quit smoking because it’s very tiring on those days,” the head nurse said.

According to another nurse on duty, despite staff concerns about continued overcrowding, hospital management has yet to implement a long-term plan to address the problem.

“I feel a system failure from above,” they said. “This is a system error.”

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