Description of Ambulance Transfer of Care

Hospitals play a critical role in assuring that 9-1-1 ambulances are available for the next 9-1-1 call.  Ambulance patient offload times (APOT) are calculated for all hospitals who receive patients from Contra Costa County. 

Timely EMS patient transfer of care is known to improve the availability of ambulances and patient safety. The standard metric used to calculate APOT is the difference of time from the ambulance arriving at the hospital to the time care is transferred to hospital staff. Transfer of care is defined as the patient being transferred from the EMS gurney and having completed an appropriate verbal report to receiving hospital staff. Activities performed after transfer of care is completed (e.g., ambulance clean up and restock) are not considered in the APOT calculation.

The expectation is that 9 out of 10 patients are transferred to the care of hospital staff within 20 minutes of ambulance arrival. Although uncommon, patient offload delays in excess of 30 minutes do occur. Transfers in excess of 60 minutes are classified as "Never Events" and are investigated on a case by case basis. 

Information presented is based on patient data provided by 9-1-1 ambulance providers.

APOT Performance - Previous 7 days

Previous 7 days data is updated daily Monday through Friday.

9-1-1 Transport Volume - October 2018

APOT Performance - October 2018

Hospital patient offload times are a critical element in the performance of our EMS system. Transferring care of an EMS patient to hospital staff facilitates ongoing care as well as releasing the ambulance back into the EMS system. 

Delayed offload times can directly impact the availability of ambulances. For this reason, the offload time standard for Contra Costa County has been set at 20 minutes. Thus, the expectation is that each patient transported by ambulance to a hospital be transferred to the care of receiving hospital staff within 20 minutes of arrival at the hospital, 90% of the time.

The Contra Costa EMS Agency has regulatory jurisdiction of hospitals within Contra Costa County. However, we work in close partnership with neighboring EMS agencies to ensure that similar standards exist for patients transported to out of county hospitals.

Never Events

"Never Events" are patient transfer of care delays of 60 minutes or more. They are serious, largely preventable patient safety incidents that impact not only the continuum of patient care, but also the availability of EMS resources to respond to  9-1-1 responses in local communities.

APOT Performance - Historical Comparison

Monthly APOT performance provides a glimpse into the larger EMS system. In order to better understand APOT by facility, we trend performance month over month. This provides a more accurate portrayal of long term performance while highlighting anomalies that may occur.

The EMS Agency works with ambulance providers, hospital and Emergency Department (ED) leadership to ensure prompt patient transfer in the ED. Prompt transfer enables timely definitive care and the return of emergency ambulances into the system for the next 9-1-1 response. 

The Contra Costa County Emergency Medical Services Agency, in compliance with Health and Safety Code 1797.120, calculates and reports ambulance patient offload times using standardized criteria and methodology monthly.