Patterns in California Ambulance Patient Offload Times by Local Emergency Medical Services Agency

Importance Ambulance offload delays are a timely and crucial issue with implications for patients, emergency medical services (EMS) agencies, hospitals, and communities. Published data on recent patterns in ambulance patient offload times (APOTs) are sparse. Objective To examine patterns in APOT by California local EMS agency and variation between and within local agencies. Design, Setting, and Participants This cohort study used APOT reports from the California EMS Authority and local EMS agencies between January 1, 2021, and June 30, 2023, to examine patterns in ambulance offload times. County-level population data were collected from the US Census Bureau to calculate mean annual offloads per 1000 population. Exposure Ambulance transport to emergency departments. Main Outcomes and Measures Ambulance offload volumes, mean annual offloads per 1000 population, APOT-1 (a reporting metric that includes the 90th percentile ambulance offload time and number of offloads to a specific hospital) weighted means (SDs), and APOT-1 medians (IQRs). Results A total of 5 913 399 offloads across 34 California local EMS agencies were analyzed. The APOT-1 weighted mean (SD) across the state was 42.8 (27.3) minutes, and the median (IQR) monthly hospital-level APOT-1 was 28.9 (14.9-46.3) minutes. Nearly one-half of local EMS agencies (16 of 34 [47.1%], accounting for 79.2% of all offloads) experienced an APOT-1 weighted mean greater than the 30-minute standard set by the state. Moreover, 20 of 33 local EMS agencies (60.6%) reported an annual APOT-1 weighted mean that was worse in 2023 than 2021. Conclusions and Relevance In this cohort study, approximately half of all agencies consistently reported ambulance offload times greater than the 30-minute state standard, and there was significant variation between and within agencies. These findings may spur collaborative efforts between stakeholders to determine the most effective strategies for addressing systemic issues resulting in long APOT across California.