BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1223
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|AUTHOR: |O'Donnell |
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|VERSION: |June 30, 2015 |
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|HEARING DATE: |July 8, 2015 | | |
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|CONSULTANT: |Vince Marchand |
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SUBJECT : Emergency medical services: ambulance transportation.
SUMMARY : Requires the Emergency Medical Services Authority (EMSA) to
adopt a statewide standard methodology for the calculation and
reporting by a Local Emergency Medical Services Agency (LEMSA)
of ambulance patient offload time, and permits a LEMSA to adopt
policies and procedures for calculating and reporting ambulance
patient offload time using the statewide methodology adopted by
EMSA. Requires, if a LEMSA adopts a policy for calculating and
reporting ambulance patient offload time, to establish criteria
for the reporting of, and quality assurance follow-up for, a
"nonstandard patient offload time."
Existing law:
1)Establishes EMSA, which is responsible for the coordination
and integration of all state activities concerning EMS,
including the establishment of minimum standards, policies,
and procedures.
2)Requires EMSA, utilizing regional and local information, to
assess each EMS area or the system's service area for the
purpose of determining the need for additional emergency
services, and the coordination and effectiveness of EMS.
3)Requires EMSA to develop planning and implementation
guidelines for EMS systems which address specified components,
including communications, system organization and management,
and data collection and evaluation.
4)Authorizes counties to develop an EMS program and designate a
LEMSA responsible for planning and implementing an EMS system,
which includes day-to-day EMS system operations.
AB 1223 (O'Donnell) Page 2 of ?
5)Establishes an 18-member Commission on EMS, within the
California Health and Human Services Agency (HHSA). Defines
the duties of the Commission to include reviewing regulations,
standards, and guidelines developed by EMSA; advising EMSA on
a data collection system; advise on emergency facilities and
services, emergency communications, medical equipment,
personnel training, and various aspects of the EMS system;
and, to make recommendations for further development of the
EMS system.
This bill:
1)Requires EMSA to develop, and after approval by the Commission
on EMS, adopt a statewide standard methodology for the
calculation and reporting by a LEMSA of ambulance patient
offload time, using input from stakeholders, including, but
not limited to, hospitals, LEMSAs, and public and private EMS
providers.
2)Defines "ambulance patient offload time" as the interval
between the arrival of an ambulance patient at an emergency
department, and the time that the patient is transferred to an
emergency department gurney, bed, chair, or other acceptable
location and the emergency departments assumes responsibility
for care of the patient.
3)Permits a LEMSA to adopt policies and procedures for
calculating and reporting ambulance patient offload time, and
requires a LEMSA that adopts these policies and procedures to
do all of the following:
a) Use the statewide standard methodology for
calculating and reporting patient offload time
developed by EMSA pursuant to this bill; and,
b) Establish criteria for the reporting of, and
quality assurance follow-up for, a "nonstandard
patient offload time," as defined in this bill.
4)Defines "nonstandard patient offload time" as an offload time
that exceeds a period of time designated in the criteria
established by the LEMSA, but excludes from this definition
instances in which the offload times exceeds the designated
period of time due to acts of God, natural disasters, or
manmade disasters.
FISCAL
AB 1223 (O'Donnell) Page 3 of ?
EFFECT : According to the Assembly Appropriations Committee,
this bill will result in minor and absorbable costs to EMSA
(General Fund or federal grant funds).
PRIOR
VOTES :
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|Assembly Floor: |76 - 0 |
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|Assembly Appropriations Committee: |15 - 0 |
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|Assembly Health Committee: |19 - 0 |
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COMMENTS :
1)Author's statement. According to the author, when someone is
picked up by an ambulance, they are taken to a hospital
emergency department. Once the patient is in the ambulance the
EMS crew becomes responsible for their care until they are
signed over to hospital staff.
Patients who are suffering from a serious medical condition are
quickly admitted into the hospital, but that is often not the
case with patients with minor issues, who have to wait for a
hospital bed to become available. A national study found that
patient offload times had more than doubled since 2006, from
25 minutes to 45 minutes. Offload times in some parts of
California can be much longer. EMSA reports that 13 of the
states' 33 LEMSAs identified the problem of ambulance patient
offload times as an issue. These 13 agencies serve 70 percent
of the state's population. While some individual counties and
hospitals have taken actions to alleviate the issue there has
been no uniform, statewide, or comprehensive attempts to solve
the problem of patient offload times or even define it.
Without a common vocabulary when discussing this issue the
state can't begin to identify the problem let alone devise
remedies.
2)Background and creation of toolkit to address offload delays.
In 2013, the California Hospital Association and EMSA created
the Ambulance Patient Offload Delay Collaborative to analyze
and develop solutions for the offload delays that were
increasing pressure on both hospitals and ambulance providers.
The goals of this collaborative were to: 1) develop
AB 1223 (O'Donnell) Page 4 of ?
standardized language, definitions, metrics and reporting
opportunities for ambulance patient throughput; 2) identify
ways to reduce delays and improve transfer times; and, 3)
assist local jurisdictions in developing processes and
sustainable goals to reduce the incidence of ambulance patient
offload delays. In a national study involving 200 cities,
including some in California, the national average wait time
for handing off ambulance patients has doubled from 20 minutes
in 2006 to more than 45 minutes. Through survey research, the
collaborative learned that the offload delay problem in
California is not uniform or consistently reported. Of the 124
hospitals that responded to the survey, 74 (or 60%) said that
offload delays were "neutral" or "not significant," which was
consistent with what 19 out of 33 LEMSAs (58%) reported as
well. In contrast, 45 hospitals and 13 LEMSAs reported that
offload delays were "extremely significant," "very
significant," or "somewhat significant." However, those 13
LEMSAs reporting a problem represent regions that include 70%
of California's population.
As a result of this collaborative effort, in August of 2014
the Toolkit to Reduce Ambulance Patient Offload Delays in the
Emergency Department (Toolkit) was published by the California
Hospital Association. The Toolkit includes definitions,
process guidelines and strategies to be considered to evaluate
current practices and develop specific process improvements at
the local level. The theme of the Toolkit was that local EMS
systems and hospitals are unique, and that collaborative
problem solving should be used to identify and solve problems
locally. However, the Toolkit did identify three key factors
for success, starting with improving the emergency department
intake process, followed by continuous quality improvement
measures, and hospital and LEMSA collaboration.
3)Related legislation. AB 503 (Rodriguez), would permit a
hospital to release patient-identifiable medical information
to an emergency medical services provider, to a LEMSA, or to
EMSA, for quality assessment and improvement purposes. AB 503
passed the Senate Health Committee by a vote of 8-0 on July 1,
2015.
AB 1129 (Burke), requires an emergency medical care provider,
when submitting data to a LEMSA, to use an electronic health
record system that is compatible with specified standards, and
that includes those data elements that are required by the
AB 1223 (O'Donnell) Page 5 of ?
LEMSA. Prohibits a LEMSA from mandating that a provider use a
specific electronic health record system. AB 1129 passed the
Senate Health Committee by a vote of 8-0 on July 1, 2015.
4)Prior legislation. AB 1621 (Lowenthal, 2014), would have
required EMSA to adopt a single statewide standard for the
collection of information regarding pre-hospital care for
CEMSIS, required EMSA to develop standards for electronic
patient care records systems used by LEMSAs and local
pre-hospital EMS providers to ensure compatibility with
CEMSIS, and required LEMSAs to submit patient information to
EMSA utilizing the single statewide standard in a timely
manner. AB 1621 was held on the Senate Appropriations
Committee suspense file.
AB 1975 (R. Hernández, 2014) would have required LEMSAs to
contract with the American College of Surgeons every five
years to conduct a comprehensive assessment of their regional
trauma system. AB 1975 was held on the Assembly Appropriations
Committee suspense file.
SB 535 (Nielsen, 2013), would have increased the membership of
the EMS Commission from 18 to 20 members, and required the
additional members to be an air ambulance representative
appointed by the Senate Committee on Rules, and representative
appointed by the Speaker of the Assembly from a public agency
that provides air rescue and transport. SB 535 was vetoed by
the Governor.
5)Support. According to the author, this bill is sponsored by
the California Fire Chiefs Association (CFCA), which states in
support that hospital emergency departments are more crowded
and busier than ever, which means that EMS responders are
spending more of their time waiting to offload patients at
emergency departments than fulfilling their primary duty of
responding to emergency calls. CFCA states that this bill
seeks to help alleviate these issues by requiring EMSA to
develop a methodology for determining an acceptable amount of
time for EMS crews to offload their patients at emergency
departments. The California Ambulance Association (CAA) states
that it supports this bill because it believes that it will
ultimately result in cost savings to the EMS system. According
to CAA, patient offload time has been a significant problem
for ambulance providers. CAA agrees that a crucial first step
in dealing with this issue is to properly identify and define
AB 1223 (O'Donnell) Page 6 of ?
metrics to measure the issue. The California Professional
Firefighters states in support that this bill represents a
good first step toward the development of standards to
expedite the transfer of care between ambulance personnel and
the emergency department staff of a general acute care
hospital and mitigate delays in returning ambulances and
pre-hospital care personnel to the EMS system. Paramedics Plus
states in support that a five minute wait time reduction in
Alameda County equates to one 24 hour ambulance deployment per
day back into the 911 EMS system.
6)Opposition. The California Hospital Association (CHA) states
in opposition that numerous issues contribute to ambulance
patient offload delays and emergency department crowding, and
that hospitals are not the main problem. According to CHA,
excess demand for emergency services, for the most part, is
beyond both hospitals and EMS providers to exclusively solve.
CHA states that standardization of ambulance patient offload
delay methodology is a laudable goal, however, it does not
address the individual local needs of each LEMSA and
neighboring hospitals to solve problems with their existing
resources. Finally, CHA states that the Ambulance Patient
Offload Delay initiative has been operating for more than two
years with many regional collaboratives already working
collectively and cooperatively to solve this issue, and that
legislation is unnecessary. According to CHA, one local area
has discovered that offload delays are a product of their
counties' massive population growth with increased Medi-Cal
patients seeking care in the area emergency departments, while
another area showed that delays were attributable to the EMS
crews restocking and completing their paperwork. CHA states
that legislation that requires measurements that will be used
in a retaliatory manner against hospitals is unfair and
unnecessary.
SUPPORT AND OPPOSITION :
Support: California Fire Chiefs Association (sponsor)
California Ambulance Association
California Professional Firefighters
California State Firefighters' Association
League of California Cities
Paramedics Plus
Oppose: California Hospital Association
AB 1223 (O'Donnell) Page 7 of ?
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