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In September, the Sierra-Sacramento Valley Emergency Medical Services Agency (S-SVEMSA) put forth a proposal to fine hospitals for missing ambulance patient offload time (APOT) targets. As is the case with other local emergency medical services agencies (LEMSAs), emergency medical services providers have complained about APOT at certain facilities. In this case, the facilities that would be most affected by the proposal were those in the most densely populated portion of the 10-county jurisdiction. On Nov. 17, S-SVEMSA officially postponed any further consideration of the policy until late spring 2021.

Hospitals within the S-SVEMSA territory have worked diligently since September to redirect the focus on APOT management from a punitive system of fines to a collaborative approach of operational improvement. The change in tone from the September Regional Medical Control Committee (RMCC) meeting to last week’s RMCC meeting was remarkable. Rather than emphasizing the symptom (high offload times), the conversation shifted to causes (drivers of EMS volume, drags on through-put, and inaccurate times).

S-SVEMSA staff explained that the decision to postpone any further consideration of fines resulted from:

  • Recent APOT improvement at facilities with the highest times
  • Current inconsistencies and inaccuracies in measuring APOT by EMS providers
  • The resurgence of COVID-19
  • Hesitance to be the first LEMSA in California to institute fines on hospitals
  • The fact that greater attention and collaboration are now being directed at the problem

S-SVEMSA will lead an effort to ensure that all ambulance crews record APOT properly and consistently. It will try to confirm the accuracy of the data and will now review APOT data at every RMCC and board meeting to bring about a more concerted and consistent focus on measurement and improvement.

Tremendous credit goes to Placer County Supervisor Jim Holmes, chair of the Board of Directors. Following conversations with local hospital leaders and other health officials, he asked to postpone the consideration of fines until late next spring to allow for more cooperation between staff and the most-affected hospitals. Coupled with the advocacy of hospital leaders and clinicians with other board members and S-SVEMSA staff, the coordinated efforts have prevented the setting of a negative statewide precedent.