Every second counts in an emergency, and when it comes to medical emergencies, time is of the essence. The time it takes for an ambulance to offload a patient at the emergency department (ED) can make all the difference; the longer the wait, the more critical their condition can become. It's an emotional and stressful situation for patients and their loved ones, who are already worried about the outcome of their medical emergency.
As the population of Sacramento County continues to grow, so do the demands on its emergency medical services. One crucial metric that affects patient outcomes and the overall efficiency of emergency medical services is the Ambulance Patient Off-load Time (APOT). The time interval between the arrival of an ambulance patient at an ED and the time the patient is transferred to the ED gurney, bed, chair or other acceptable location and the emergency department assumes the responsibility for care of the patient. In Sacramento County, that time has hit a high of 72 minutes, but the County has an ambitious goal to drop that time to 20 minutes!
This goal comes as Assembly Bill 40, which takes effect on July 1, 2024, will require every local EMS agency to develop a plan not to exceed 30 minutes for 90% of ambulance arrivals and report the standardized time to the authority.
In light of this change and to better serve our community, Sacramento County, along with prehospital providers, local hospitals, interested community members and Sacramento County Board of Supervisors Kennedy and Hume, came together on February 13 to share their innovations and best practices to address the Ambulance Patient Off-Load Time (APOT) crisis.
At the event, Dr. Gregory Kann stated the importance of sharing ideas and innovations to create better services for all, adding that out of this crisis comes opportunity!
Sutter Roseville was one of the presenters who shared how they implemented a real-time data system to monitor their APOT. By using their medical health record system, EPIC, they tracked a patient's emergency room trip from entrance to transfer, allowing them to identify obstacles and course-correct any issues. The hospital leadership also educated staff to help identify when a patient needed ER treatment or could be moved to another department or service. These efforts helped the hospital reduce their APOT from 1 hour and 40 minutes to 31 minutes!
Another presentation came from the Sacramento Metropolitan Fire District (SMFD), which approached the issue of APOT through a different lens. They implemented the County's revised protocol (Policy #5050 – Destination), which authorizes the patients be taken to their medical health system's hospital, instead of the closest hospital, allowing for faster treatment since the hospital had their medical records. They also determined if a patient needed to be directly taken to the ER or if they could safely wait in the lobby. Finally, the fire department partnered with other ambulance providers to provide additional ambulances to support the 911 system. SMFD also implemented a Mobile Integrated Health program, which means they have a Physician Assistance / Nurse Practitioner teamed with a paramedic who can respond to calls to determine what a patient may need and how they can be treated at the scene without going to the ED to assist with decreasing APOT. These innovations aim to get patients to the right place the first time, whether that's the ER, lobby, or another service.
Overall, the event demonstrated that there is a strong commitment among local hospitals, prehospital providers, and the Sacramento County Board of Supervisors to improve APOT and emergency medical services. With continued collaboration, innovation and inspiration, Dr. Kann emphasized that these conversations are what will fuel the plan that will lead to better APOT and deliver better outcomes for patients in Sacramento County.