Prehosp Emerg Care. 2019 May-Jun;23(3):319-326. doi: 10.1080/10903127.2018.1525456. Epub 2018 Oct 25.
Ambulance patient offload time (APOT) also known colloquially as "Wall time" has been described in various jurisdictions but seems to be highly variable. Any attempt to improve APOT requires the use of common definitions and standard methodology to measure the extent of the problem.
An Ambulance Offload Delay Task Force in California developed a set of standard definitions and methodology to measure APOT for transported 9-1-1 patients. It is defined as the time "interval between the arrival of an ambulance at an emergency department and the time that the patient is transferred to an ED gurney, bed, chair or other acceptable location and the ED assumes responsibility for care of the patient." Local EMS agencies voluntarily reported data according to the standard methodology to the California EMS Authority (State agency).
Data were reported for 9-1-1 transports during 2017 from 9 of 33 local EMS Agencies in California that comprise 37 percent of the state population. These represent 830,637 ambulance transports to 126 hospitals. APOT shows significant variation by EMS agency with half of the agencies demonstrating significant delays. Offload times vary markedly by hospital as well as by region. Three-fourths of hospitals detained EMS crews more than one hour, 40% more than two hours, and one-third delayed EMS return to service by more than three hours.
This first step to address offload delays in California consists of standardized definitions for data collection to address the significant variability inherent in obtaining data from 33 local agencies, hundreds of EMS provider agencies, and 320 acute care hospital Emergency Departments that receive 9-1-1 ambulance transports. The first year of standardized data collection of ambulance patient offload times revealed significant ambulance patient offload time delays that are not distributed uniformly, resulting in a substantial financial burden for some EMS providers in California.
救护车患者下车时间（APOT），也俗称“Wall time”，已在不同司法管辖区进行描述，但似乎差异很大。任何改善 APOT 的尝试都需要使用共同的定义和标准方法来衡量问题的严重程度。
加利福尼亚州的救护车下车延误工作组制定了一套标准定义和方法，用于测量运送的 9-1-1 患者的 APOT。它被定义为“救护车到达急诊部和患者转移到急诊部担架、床、椅子或其他可接受的位置之间的时间间隔，急诊部负责患者的护理”。当地的 EMS 机构根据标准方法自愿向加利福尼亚州 EMS 管理局（州机构）报告数据。
2017 年，加利福尼亚州 33 个当地 EMS 机构中的 9 个报告了 9-1-1 转运的数据，占该州人口的 37%。这些代表了 830637 次救护车转运至 126 家医院。APOT 因 EMS 机构而异，一半的机构表现出明显的延迟。下车时间因医院和地区而异。四分之三的医院扣留 EMS 工作人员超过一小时，40%的医院扣留超过两小时，三分之一的医院扣留 EMS 人员返回服务超过三小时。
这是加利福尼亚州解决下车延误的第一步，包括数据收集的标准化定义，以解决从 33 个地方机构、数百个 EMS 提供商机构和 320 家接收 9-1-1 救护车转运的急症护理医院急诊科获取数据时固有的巨大差异。标准化的救护车患者下车时间数据收集的第一年显示出明显的救护车患者下车时间延迟，且分布不均匀，这给加利福尼亚州的一些 EMS 提供商带来了巨大的财务负担。
