Across Ontario, crowded hospital emergency departments are under pressure to care for an increasing number of patients with limited existing resources. As one of the busiest Emergency Departments (EDs) in the province, wait times for patients brought to ED by ambulance has become an ongoing challenge; tying up Niagara Emergency Medical Services (NEMS) paramedics during transfer of care, resulting in: delays in patient care, increased risk to patients, and increased workload, stress and fatigue of staff.

To address this multi-factorial systems issue, NH and NEMS partnered to launch 7 joint initiatives to improve ambulance offload time (see Appendix 1). Included in these initiatives was “Fit-2-Sit,” a transformative program adopted with permission from the United Kingdom (UK) National Health Service (NHS) to improve flow and outcomes through mobility-driven interventions.

After 3 months of testing and evaluation, NH and NEMS moved to full implementation of the initiatives in April 2018. From April-October 2017, the offload time at the 90th percentile was 114 minutes; one year later, it had dropped to 105 minutes. For Niagara EMS, this equates to three extra ambulances available each day.

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