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Last week, shortly after state lawmakers were sworn in for the 2023 legislative session, Assembly member Freddie Rodriguez (D-Pomona) introduced Assembly Bill (AB) 40, which aims to reduce the time it takes to transfer patients arriving at hospitals via ambulance.
Many of the bill’s components are helpful, such as development of a public education campaign to encourage efficient use of the 911 system and creation of an electronic signature tracking process to better capture the moment when transfer of care from emergency medical services (EMS) providers to hospitals takes place. However, a proposal in the bill to establish a statewide 20-minute standard 90% of the time to offload ambulance patients is deeply concerning.
This proposal not only threatens patient safety, but also would further strain the ability of hospitals to deliver care to all in need, especially given that only 15% of patients arrive at an emergency department by ambulance. Of those patients who arrive by ambulance, 77% are lower acuity and do NOT need emergency care.
The bottom line is that patients should be treated in order of greatest need, and the manner in which people arrive at a hospital should not be artificially weighted. Doing so would push hospitals to give greater consideration to a patient who came via ambulance, even if their condition was less serious than someone who was given a ride by a family member or friend.
The creation of a statewide standard is problematic for other reasons as well:
- It fails to account for the historic, nationwide health care workforce shortage, which inhibits the ability to treat patients more quickly.
- It fails to consider local conditions, such as available behavioral health resources, ambulance capacity and capability, the risk factors faced by populations within a geographic area, the lack of primary care providers in an area, the lack of discharge options, a hospital’s physical hospital, and more.
- It fails to address the significant gaps and unanswered questions around patient offload data, where hospitals and EMS providers often have different transfer of care completion times for the same patient and there is no process to validate data that ambulance providers send to the state.
- It fails to account for frequent and substantial surges in hospital volume, currently driven by the tripledemic of flu, RSV, and COVID-19 (hospital emergency department volume overall in California has increased 42% over the past seven years).
In fact, as recently as 2014, a widely respected collaborative that included state emergency officials, hospital leaders, and EMS providers, recommended that local emergency management service agencies set their own standards based on local factors and employ a flexible window of 15 to 30 minutes to complete the transfer of care for 90% of patients arriving at a hospital via ambulance.
That’s why CHA is “opposed unless amended” to AB 40, so we can preserve the positive aspects of a bill that will help deliver care to patients as quickly as possible and eliminate the dangerous statewide standard.
Hospitals are eager to be a part of the solution to reduce ambulance patient offload delays, and support many of the proposed initiatives in AB 40, but patient safety cannot be sacrificed in any way to meet a statewide time constraint.
