how to read an ambulance patient offload time report

What is Ambulance Patient offload time (APOT)?

The arrival of an EMS-transported patient to the hospital implies that a transfer of the patient from the transporting vehicle into the ED must take place. This ambulance patient offload time (APOT) requires the physical movement of patients who reflect the spectrum of emergency medical conditions. Considerations during the APOT include:

What happens when an ambulance arrives at a hospital?

When an ambulance bearing a patient arrives at a hospital, a period of transition occurs for that patient. For example, any tubes or wires attached to the patient must be managed, a decision made on what equipment to carry in with the stretcher, and the patient must be relocated physically to a hospital bed, chair, or other location.

How long do hospitals wait for EMS offload?

Offload times vary markedly by hospital as well as by region. Three-fourths of hospitals detained EMS crews more than one hour, 40% more than two hours, and one-third delayed EMS return to service by more than three hours.

What is the time interval between ambulance and Ed?

It is defined as the time "interval between the arrival of an ambulance at an emergency department and the time that the patient is transferred to an ED gurney, bed, chair or other acceptable location and the ED assumes responsibility for care of the patient."

What is offload delay?

In this article, ambulance offload delay refers to a situation where a lack of ED beds prevents incoming ambulance patients from being transferred to hospital staff. In this instance, patients remain on ambulance stretchers under the care of Emergency Medical Services (EMS).

What is ambulance wall time?

Wall time means that, at times, EMS paramedics and EMTs staffing ambulances and the patient they transported to the hospital must wait along the wall in the emergency department for hospital staff to assume care of the patient. This wall time results from a shortage of beds and/or staff in the ED.

How long does it take to offload an ambulance in California?

A statewide initiative in California measured the interval from ambulance arrival to receiving nurse handover signature and found a mean offload time of 36 minutes, with a wide range of durations. 1

What happens when an ambulance arrives at a hospital?

When an ambulance bearing a patient arrives at a hospital, a period of transition occurs for that patient. For example, any tubes or wires attached to the patient must be managed, a decision made on what equipment to carry in with the stretcher, and the patient must be relocated physically to a hospital bed, chair, or other location.

What is an APOT evaluation?

The ongoing evaluation of the patient during the APOT by the transporting staff.

What is an APOT in EMS?

This ambulance patient offload time (APOT) requires the physical movement of patients who reflect the spectrum of emergency medical conditions. Considerations during the APOT include:

What is the APOT in healthcare?

The APOT presents a critical point in patient care: responsibility is transferred to new providers, a physical movement of the patient must occur, and patient monitoring can suffer in the interim.

When must patient assessment be continued?

Ongoing patient assessment, including the observation of the patient for potentially life-threatening emergencies and the response to care, must be continued until the patient is under the direct care of the ED receiving personnel.

Is there a significant potential for patient deterioration during the APOT?

Our study found that 100% of EMS medical directors surveyed agreed that there’s a significant potential for patient deterioration during the APOT. (See Figure 1.)

What is non standard patient offload time?

For the purposes of statute implementation, it will be interpreted to mean any time interval that exceeds the APOT standard established by the LEMSA. Many LEMSAs currently define this as Ambulance Patient Offload Delay (APOD) consistent with the metrics and definitions contained in The Ambulance Patient Offload Toolkit5.

What is an APOT process?

APOT is defined in statute as a time interval, therefore process controls must be established for collecting the beginning and ending timestamps to be utilized for the calculation of the time interval.