The second APOT Summit took place at the Sacramento Metro Fire District headquarters in Mather. Photo courtesy of Casey Camacho

SACRAMENTO COUNTY, CA (MPG) - Sacramento County is making tremendous progress in its goal to achieve a shorter ambulance patient offload time (APOT), according to county officials.

APOT is defined as “the time between when an ambulance arrives at a hospital and when the patient is transferred to an emergency department for care. The time does not stop recording until the emergency department fully assumes responsibility of care for the patient,” according to Sacramento County Public Health officials. 

On Oct. 3, Sacramento County Public Health hosted the second Ambulance Patient Offload Time Summit, following the first summit on Feb. 13.

The reason for these meetings is the 2023 passage of Assembly Bill 40, which stated that local emergency medical services (EMS) agencies needed to establish an offload threshold that did not exceed 30 minutes and required a report to the California Emergency Medical Services Authority by July 1 of this year. Additionally, the bill mandated that hospitals submit ambulance patient offload time plans to the authority by Sept. 1 of this year.

The Oct. 3 meeting highlighted the region’s overall performance, celebrated the successes of the county, showed status reports and enhancements, and included presentations from regional hospital representatives who explained how they were making the changes and improvements.

According to Sacramento County public information officer Casey Camacho, Sacramento County entered 2024 with a 64-minute offload time, which was the worst in the state. Sacramento County managed to decrease that to 39 minutes halfway through September. The California Emergency Medical Services Commission received a county progress report on Sept. 19, which highlighted Sacramento County as having the most improved APOT times statewide.

The summit opened and closed with remarks from Greg Kann MD, the Sacramento County Emergency Medical Services Agency (SCEMSA) Medical Director.

Kann acknowledged how the county has made a “phenomenal change” in the decrease in its offload times. He noted that the number of patients has stayed consistent, even with the changes in the way the hospitals are operating.

“Our hospital partners are doing the things they need to do,” Kann said.

Beyond decreasing offload time, Kann said, Sacramento County is working to use telemedicine to “offload low acuity patient volumes,” meaning telemedicine could help the less-severe medical cases, taking down the volume of ambulance offloads.

“The folks down in Elk Grove and Galt have really doubled down on their commitment to making telemedicine work,” Kann said.

Next, Sac Metro Fire EMS Director Jon Rudnicki spoke primarily about how the patient is always the priority. Rudnicki showed two videos of two different patients whose lives were saved due to the speed and timing of the process of Sacramento emergency medical services, one being a toddler who was revived.

Rudnicki ended with a challenge to his fellow emergency medical services workers: “Why would we not aim for greater? Why should we settle for the benchmark?”

Following Rudnicki were presentations from both Mercy San Juan officials and Kaiser Roseville officials, who spoke about effective changes they made to bring their ambulance patient offload time down.

Kimberly Adams and Chris Britton of Kaiser Roseville highlighted their strategy, which included creating an APOT task force and utilizing hospital hallways to serve patients. According to Britton, Kaiser Roseville is the second busiest emergency room in the state, and they see around 144,000 patients in a year, with 10-15,000 seen each month. Adams referred to APOT as a “team sport,” and Britton cited “such good collaboration” as one of their successes.

Amelia Hart of Mercy San Juan was inspired by what Kaiser Roseville was doing and said her team took similar steps. According to Hart, Mercy San Juan receives the most ambulances in Sacramento County, so it was a large effort to bring ambulance patient offload time down.

“Everyone is aligned and invested in this,” Hart said. 

District 5 Supervisor Pat Hume briefly spoke about the progress that the county is making and applauded the dramatic change in ambulance patient offload time.

“The energy in this room is palpable compared to where we were in February,” Hume said, stressing the “magnitude, the importance, the impact” of what emergency medical services workers are doing.

Next, Sacramento State assistant professor Dale Ainsworth, PhD, gave insight into how changes in processes, especially in an organization, can be difficult and gave tips on how to make them “stick.”

Sacramento County Behavioral Health Director Ryan Quist touched on more changes the county is facing regarding Senate Bill 43, which changes who can be on involuntary hold in an emergency room, another factor in determining ambulance patient offload time.

Ending the summit were speakers from the Growth Factory, an innovation team helping Sacramento County find creative ways to make changes to ambulance patient offload time. Monique Brown of the Growth Factory said they are working on a database called At Orchid, which will boost hospitals’ ability to track data and timing of emergency room patients.

Kann reiterated a final point: “patient safety is our Number One priority.”

For more information about the Sacramento County Department of Emergency Medical Services Agency, visit https://dhs.saccounty.gov/pub/ems/Pages/EMS-Home.aspx.