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L.A. can, and should, solve its 'wall time' problem

L.A. is wasting money and endangering lives as ambulance crews wait for patients to be admitted to hospitals
For once, L.A. can save money and improve services with an eminently doable Fire Department fix

Some issues in government are genuinely complex or divisive. Many defy solutions — ending violence in Gaza, say, or protecting children in foster care. What I am about to describe is not one of those issues. This one is costing taxpayers and risking lives, and yet fixing it is eminently doable. The problem is known as "wall time."

When Los Angeles Fire Department ambulance crews bring a patient to a hospital, the crew stays with the patient until the patient is admitted — that's required by a state law prohibiting "patient abandonment." In many cases, the wait is short: A suffering or unconscious person is brought to the emergency room, whisked from the ambulance, and the crew is back at work after 10 or 15 minutes of filling out paperwork. But other times, a patient arrives with minor injuries or problems, and he or she has to wait for a bed, sometimes for hours. When the ambulance crew has a long wait, it's called "wall time" because the crew is leaning against walls.

That's not so bad for the crews. It's boring, but they're paid either way. It is, however, hard on taxpayers, who are paying $165 an hour for an ambulance crew to sit around a hospital. It's also dangerous for anyone else who needs that crew's help.

It all adds up. Last year, by the Fire Department's calculations, its ambulance crews wasted 36,627 hours in wall time. That represented about $6 million that wasn't exactly wasted, but it wasn't put to the highest and best use either. Moreover, wall time is increasing: The number of hours spent by Los Angeles ambulance personnel stuck in waiting rooms increased by nearly 30% from 2012 to 2013.

It also creates a ripple effect, City Councilman Paul Krekorian told me last week. When ambulance crews wait at the hospital, they're not available to respond to emergencies, so response time increases and a person in genuine crisis may lose precious minutes before help arrives.

Krekorian discovered this egregious bit of waste in his capacity as chairman of the council's Budget Committee. He first pointed it out months ago, and in February he put in a motion asking Fire Department officials to investigate the issue and return with recommendations. As of last week, the department still had not responded.

That's not all the department's fault. Krekorian deliberately declined to set a deadline for the report, saying he preferred a thorough deliberation to a quick one. But as he's considered this issue, he has come up with some promising ideas of his own for addressing the situation.

The Fire Department could, for instance, hire nurses or other medical personnel and assign them to hospital emergency rooms, especially at busy hospitals during busy periods. When ambulance crews arrive, they could hand over their patients to that nurse, who could then take custody of the patient until he or she was admitted to the hospital, allowing the ambulance to return to service. It would add a small number of salaries to the budget, but there are still potential time and money savings with such a scheme.

Alternatively, ambulance crews could be given more options for where to take patients. Imagine that a crew responded to a 911 call and found a person with a broken finger; once they've put the finger in a splint, do they really need to take the patient to an emergency room for follow-up? Surely, Krekorian suggests, a clinic could handle that task.

This is not just an L.A. problem, as Frank Lima, president of the firefighters union, United Firefighters of Los Angeles City, pointed out to me last week. The prohibition against patient abandonment is a California law, so it applies throughout the state and to private ambulances as well as public ones.

True, but Los Angeles has special characteristics that make the issue especially acute. The city's large population and geography mean that L.A. crews are exceptionally busy; the large number of uninsured people means that emergency rooms are often especially crowded with people seeking routine medical care (a problem that may subside as Obamacare brings more people onto the insurance rolls); and a large population of mentally ill people creates special complications for emergency room and ambulance personnel.

All the more reason wall time matters. At the very least, the councilman has sketched out promising ways for doing that. Krekorian and Lima agree that placing handoff medical personnel in emergency rooms would free up crews, alleviate backups, save money and speed up help to people in crisis. The same is true for making better use of clinics. The Fire Department may come up with additional recommendations.

Wall time is that rare problem that is both serious and solvable. All that remains is for the city to fix it.

jim.newton@latimes.com

Twitter: @newton_jim

Copyright © 2015, Los Angeles Times
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