CEO Messages

As APOT Issues Linger, Steps Are Being Taken to Address the Problem  

Ambulance patient offload times (APOT) — a longstanding issue that has been exacerbated by COVID-19 — remain problematic in many parts of our region. While the APOT issues are ultimately realized inside the hospital, a significant number of the factors causing APOT delays occur outside the hospital. These include:  

  • Lack of available primary care, leading many to seek care in the emergency department (ED)
  • Inappropriate use of EDs for non-urgent care 
  • Challenges discharging patients from the hospital to nursing homes and other post-acute care settings 
  • A dramatic increase in behavioral health needs and limited other care options for those individuals, with EDs as a last resort 
  • Increasing numbers of individuals experiencing homelessness who seek refuge in hospital EDs 

And although not every hospital in our region has been impacted in the same way by APOT, for those that are in the thick of it, know that we are working to alleviate these delays. 

Earlier this year, Hospital Council was asked to participate in the California Emergency Services Authority’s (EMSA) Statewide APOT Committee. The mission of the committee is to develop advisory recommendations, including legislative or regulatory changes, and to identify and share efficiencies that reduce or eliminate ambulance patient offload delays. 

The final report is now complete, and the recommendations will be voted on next month and shared and discussed at upcoming section meetings. Hospital Council, Hospital Association of San Diego & Imperial Counties, Hospital Association of Southern California, and CHA sent a joint letter to EMSA thanking them for addressing this important issue while emphasizing some of the continuing challenges around APOT.  

In the letter, we address a few concerns in particular: 

  • An urgently needed cohesive and reliable statewide emergency medical services (EMS) data strategy  
  • Multiple data platforms that are used to track offload times 
  • Rationale for the 20-minute offload “standard” that appears to vary by agency (some local EMS agencies have a 30-minute standard) 
  • Failure to account for factors driving hospital volume, such as demographic changes, coverage expansion, and increased need 

While the offloads happen in the ED, we know that broader problems in the health care delivery system contribute to delays. To encourage appropriate use of the ED, a new website — — is designed to educate the public on where to get the right care. The site contains a guide to help those who are sick or injured decide where to go for treatment, along with links to media coverage from a recent press conference held in the Sacramento area, where APOT issues have been ongoing.