Every Minute Counts:
Improving Ambulance Offload Times
Enhancing Emergency Room Efficiency at Cambridge Memorial Hospital
Welcome to Our Proposal Overview
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In this presentation, we walk you through our structured PDSA framework addressing ambulance offload delays.
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We define the problem with key performance data, illustrate the current process from EMS dispatch to patient handover, and highlight the root causes—including unclear guidelines, training gaps, and liability concerns—that limit effective use of the Fit2Sit program.
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Our proposed solution is a targeted training initiative that empowers EMS personnel to confidently utilize Fit2Sit, thereby reducing offload delays and improving emergency response efficiency. Enjoy the presentation.
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Societal Need
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Paramedic Services (n.d.). Image of a paramedic taking care of someone on a stretcher inside of an ambulance [Photograph]. Region of Waterloo. https://www.row2023yearbook.ca/paramedic-services-initiatives/
Ambulance offload delays at Cambridge Memorial Hospital (CMH) keep paramedics waiting before transferring patients to hospital staff.
This leads to increased response times for emergencies and contributes to Code Zero events, as well as impacting the care patients receive in the Emergency Department.
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CambridgeToday (2024). Image of Cambridge Memorial Hospital[Photograph]. CambridgeToday. https://www.cambridgetoday.ca/local-news/cambridge-memorial-hospital-saw-spike-in-hallway-patients-in-early-2024-9480160
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Problem Statement
Improve the ambulance offloading process at Cambridge Memorial Hospital to reduce the total offloading time from a median time of 77 minutes to 30 minutes for CTAS level 5 patients by the end of 2025.
Background & Rationale
Vision:
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Empower paramedics to reduce offload delays using the Fit2Sit Training Initiative [6].
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Achieve transfers of CTAS Level 5 patients within 30 minutes to free up EMS faster.
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Enhance communication between EMS and hospital staff.
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Values:
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Efficiency: Streamline workflows, minimize manual tasks, and optimize ED resource allocation.
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Accountability: Employ data-driven evaluation to continuously improve and meet provincial standards.
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Collaboration: Foster coordinated teamwork and open feedback between EMS and hospital personnel.
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Equity: Ensure fair and timely access to emergency care while reducing EMS staff burnout.
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Why CMH:
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A vital community health institution in the Waterloo Region with a clear focus on reducing offload delays [1], [3], [20].
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Identified by its Quality Improvement Plan and the Region’s Paramedic Services Master Plan as a key area for improvement [1], [3].
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Supported by significant provincial funding for redevelopment and enhanced community health initiatives [4], [20].
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Overview of Problem, Process, and Root Causes
Problem
Ambulance offload delays at CMH exceed the provincial benchmark of 30 minutes for CTAS Level 5 patients, hindering timely care and reducing EMS availability [3].
Process
The process begins with ambulance arrival at the emergency department and ends when patient care is fully transferred to hospital staff. Delays during this phase disrupt the overall flow and responsiveness of the system [1] .
Root Causes
Key factors include unclear Fit2Sit guidelines, training gaps that create uncertainty (particularly around liability and shared responsibilities), and communication issues between EMS and hospital staff.
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Training Blueprint
Based on the insights collected, we design comprehensive training materials that clarify Fit2Sit eligibility, outline clear decision-making procedures, and address liability issues. This phase focuses on developing interactive modules, quick-reference guides, and scenario-based exercises that empower EMS personnel with the knowledge they need to act confidently and efficiently.
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Field Insights
In this phase, we gather critical input from EMS personnel through interviews and focus groups to better understand the reasons behind the underutilization of Fit2Sit. By identifying key barriers such as unclear guidelines, liability concerns, and communication challenges, we establish a solid foundation for targeted improvements.
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Empower & Execute
In the final phase, we pilot and implement the training initiative across the EMS team. With ongoing support and regular follow-up sessions, we monitor the impact on Fit2Sit utilization and offload delay metrics, iterating as necessary to ensure that the new practices lead to sustained improvements in patient transfer times and overall system efficiency.
Solution & Action Plan
Human Technology Ladder
This section summarizes how our training solution meets needs across the human-technology ladder:
It reduces physical strain and builds confidence among EMS personnel, enhances teamwork and communication, standardizes procedures in line with CMH's QIP and the Emergency Services Master Plan, and supports policy objectives through measurable improvements. Click the button below for more details.
Physical
The training is delivered in multiple accessible formats that reduce the physical strain on EMS personnel by enabling faster, more efficient offload decisions.
Psychological
The training reduces uncertainty and builds confidence by clearly outlining Fit2Sit guidelines and liability protections, easing the mental load on EMS staff.
Team
The initiative fosters better teamwork and communication by standardizing protocols between EMS, triage nurses, offload nurses, and other healthcare professionals ensuring coordinated and timely patient handovers.
Political
By achieving measurable improvements in offload delays and EMS performance, the solution supports healthcare policy objectives and justifies continued investment in EMS training initiatives [16].
Key Assumptions
The success of this initiative is based on several key assumptions that support the feasibility and impact of our proposed solution. We assume that:
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Staff will complete the targeted training and apply it in practice
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The Fit2Sit protocol remains a safe and appropriate option for most CTAS level 5 patients
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Cambridge Memorial Hospital (CMH) leadership will support the training initiative and align internal policies to reinforce its use
Conclusion
Our goal is to reduce ambulance offloading times at CMH from 77 minutes to 30 minutes by the end of 2025 [3].
By addressing the societal need for faster emergency care through targeted EMS training and process improvements, we will enhance patient outcomes, EMS availability, and overall system efficiency.
We invite stakeholders to support this initiative as we work toward a more responsive healthcare system.
