About Emergency Department/Trauma
California’s emergency departments (EDs) are filled to the brim (some 15 million people visit EDs every year) — often so packed that patients are forced to wait hours to be treated and ambulances are delayed in transferring patients to hospitals. Several things are behind this crisis:
- A lack of primary care clinicians that accept Medi-Cal
- A lack of post-hospital care sites (nursing homes, rehab facilities, mental health and addiction facilities, etc.) for patients and challenges with commercial insurance companies approving post-hospital care
- Workforce shortages
- Massive increases in the need for mental health and substance use disorder treatment
- Growing hospital financial distress, in part due to government payer shortfalls
- A dearth of alternative community care sites, like clinics or home settings
Without change, EDs — which accept all patients 24/7 year-round — will struggle to provide critical care to those experiencing trauma, injury, or acute medical conditions. Addressing this problem will take commitment and innovation from insurance companies, state policymakers, providers, and others to deliver better access to primary and specialty services, improved funding for ED care, and more.
In Comments on Proposed APOT Regulations, CHA Urges Stronger Collaboration and Accurate Data Publication
What’s happening: Last week, CHA submitted comments to the Emergency Medical Services Authority (EMSA) on the proposed Chapter 1.2 Ambulance Patient Offload Time (APOT) regulations, which implement provisions of Assembly Bill (AB) 40 (2023).
EMSA Re-Releases Chapter 6 and AB 40 Regulations for Comments
What’s happening: Last week, the Emergency Medical Services Authority re-released two regulatory packages: Chapter 6 Specialty Designation Regulations (trauma, STEMI/stroke, emergency medical services care for children) and Assembly Bill (AB) AB 40 Regulations (ambulance patient offload times).
Hospital APOT Reduction Protocols Due June 30
What’s happening: As a reminder, all hospitals must submit an ambulance patient offload time (APOT) reduction protocol — required under Assembly Bill (AB) 40 (2023) — to the Emergency Medical Services Authority (EMSA) annually on or before June 30. CHA recommends hospitals submit their protocols as soon as possible.
CHA Document Details Considerations for Freestanding ED Model
What’s happening: Recognizing that some hospital leaders have expressed interest in the concept of freestanding emergency departments (EDs) — which are not currently permitted in California — CHA has developed a document that outlines the current regulatory landscape and key considerations for this type of service model.
CHA Urges Continued Collaboration, Improvements to Audit Tool in Comments on AB 40 Regulations
What’s happening: Last week, CHA submitted comments to the Emergency Medical Services Authority on the proposed Chapter 1.2 Ambulance Patient Offload Time Emergency Medical Services Authority regulations, which implement provisions of Assembly Bill 40 (2023).
EMSA Releases Updated AB 40 Regulations; Comments Due March 4
What’s happening: The Emergency Medical Services Authority (EMSA) has released updated Assembly Bill (AB) 40 regulations for final rulemaking related to ambulance patient offload times (APOT), with comments due on March 4.
EMSA Approves Specialty Designation Regulations, Highlights Continued APOT Reduction Challenges
What’s happening: At its quarterly meeting last week, the Commission on Emergency Medical Services reviewed ongoing implementation challenges related to Assembly Bill (AB) 40’s ambulance patient offload time (APOT) requirements, under which hospitals must submit APOT reduction protocols annually.
Comments on Trauma/Specialty Care Regulations Due Next Week
What’s happening: Last week, the Emergency Medical Services Authority (EMSA) released updated critical care and specialty program regulations.
Infographic: Emergency Departments’ Overcrowding Crisis
Ambulance Patient Offload Times
When patients arrive at hospitals via ambulance, the goal is to transfer them to hospital care as quickly as possible. But that process can be slowed by several factors: the physical layout of a hospital, current unprecedented patient volume, increased acuity of patients’ illness or injury, and more.