Biweekly Briefing Articles

APOD Issues Continue to Strain the System

As COVID-19 cases surge not just in our region but throughout the state, a longstanding issue is wreaking havoc on the health care system.

While ambulance patient off-load delays (APOD) are nothing new — in 2014 CHA and the Emergency Management Services Authority (EMSA) convened a collaborative of engaged EMS stakeholders to identify and minimize delays — COVID-19 has only further strained the system.

It’s easy to point fingers at hospitals for causing this problem, but it’s important to note that not ALL the factors that contribute to APOD are the result of hospitals’ actions or policies. Your hospitals are dealing with unprecedented staffing challenges, along with an increase in those needing care. And non-urgent emergency department (ED) acuity is higher than ever at the same time the workforce is experiencing shortages not seen in years.

CHA and HASD&IC are working closely with EMSA and the newly created APOD Committee on this important issue, meeting regularly with stakeholders. The mission of this committee is to develop a comprehensive list of recommendations for the public health and medical system, including EMS, to reduce and eliminate APOD and life-threatening ambulance patient offload times statewide. While the group is focused on systemic long-term solutions rather than on the short term, we continue to reinforce that current data collection efforts need to be strengthened in order to improve the delays.

And earlier today, the Assembly Emergency Management Committee held an informational hearing on the issue. CHA provided testimony, which included detailing the problem (health system capacity issues that contribute to overcrowding), current and past efforts to alleviate APOD, and what’s needed. As mentioned above, CHA believes the current system of APOD tracking is rudimentary and only describes time increments. To address these delays, it was noted in today’s Assembly testimony that we need:

  • Objective and reliable real-time data. While many hospitals have embraced new technology to improve their internal data collection and are implementing innovation improvements, we simply do not have the data that will allow us to get to the root of the problem.
  • Data to help identify gaps in community services, which often contribute to patients seeking care in an ED. The social determinants of health — the conditions in the environment where people are born, live, learn, work, play, and age — must also be factored into the causes of ED crowding and ambulance patient offload delays.
  • State, county, and system-wide buy-in and the ability and the willingness of the state to invest in a long-term quality improvement process

As the pandemic — and this unprecedented surge — persist, your HASD&IC and CHA teams will continue to engage at the local and state levels on this important issue, and the many others that impact your ability to care for patients. Please don’t hesitate to reach out to me or any other member of the team if you have questions or need help.