One year ago, Sacramento County Director of Emergency Services Gregory Kann presented a startling set of statistics to the Board of Supervisors: Residents waited longer to be transferred from an ambulance to a hospital bed in Sacramento County than almost anywhere else in California.
Large percentages of patients — outside of those suffering trauma, heart attacks, strokes or other life-or-death ailments — waited about 97 minutes for a bed in January 2022 after arriving by ambulance.
These wait times have dropped in Sacramento County since the passage of Assembly Bill 40 , which required by the end of this year that California hospitals, 90% of the time, must have patients wait no longer than 30 minutes to transfer from ambulance to hospital. Now, 90% of Sacramento County patients are offloaded from ambulances within 39 minutes across regional hospitals, according to the county’s data collected through the first half of September — down from the 97-minute mark at the start of 2022 and from 64 at the start of this year.
“Collaboration and conversation and just building of trust has been a giant factor in our success,” Kann said in an interview.
Outside of life-threatening medical emergencies, it’s impossible for emergency departments to treat every person arriving for help simultaneously, leading nurses and doctors to assess whether a patient should immediately receive a bed or wait.
But the triage process in Sacramento County for years has proven woefully inefficient.
Though January 2022 was one of the peaks of the COVID-19 pandemic, some area hospitals continued to report wait times of close to 90 minutes in January 2024. Nationally, wait times hovered around 25 minutes from 2022 through 2023, according to Kann’s presentation at the Board of Supervisors meeting.
The ultimate goal is for Sacramento County to offload patients in 20 minutes 90% of the time, Kann said. Stakeholders agreed to this goal in 2016, Kann said at the meeting. But conversations to meet the 20-minute threshold ramped up with the passage of AB 40 that Kann said spurred change by helping local entities create a road map for a multifaceted problem.
Sacramento County sits in a unique region in terms of health care with a combination of 11 emergency medical service providers, private ambulances and hospitals. For every 1,000 people, 378 patients came to the emergency department in the four-county region in 2021, making it the third busiest region in California, according to the California Health Care Foundation. The only parts of the state with more emergency patients per-capita were the San Joaquin Valley and the group of Northern California counties including Butte, Humboldt, Nevada, Yuba and Sutter.
Sacramento County, Sacramento Metropolitan Fire District, hospitals and private ambulances based in Sacramento County swapped ideas and brainstormed ways to whittle down their offload timing during conferences this past year, in advance of submitting a plan outlining the reduction of wait times by Sept. 1 in accordance with AB 40.
The work allowed Sacramento County to pinpoint the system’s downfalls that led to lengthy wait times, including a different level of care offered to residents outside of Sacramento County. The county also re-examined workflows to ensure patients are offloaded and ambulances are swiftly released back into the community.
Kaiser Permanente’s emergency department in Roseville — ranked the second busiest department in all of California in 2022 — has seen wait times drop from a peak of four hours at its busiest, said Chris Britton, an assistant nurse manager at the emergency department. The hospital is just outside Sacramento County.
Typical patient wait times decreased from about 88 minutes in January 2024 to about 25 minutes in August, according to Britton’s data.
Mercy San Juan Medical Center reported a similar drop. Residents waited 83 minutes in January 2024 and now will be seen in about 30 minutes according to the hospital’s data, said Amelia Hart, an EMS coordinator at the Carmichael hospital.
What did hospitals change?
Both hospitals reworked their workflows after assigning one employee to observe the offloading process. Britton noted how emergency medical technicians gave a report on a patient at least four times, collectively amounting to 15 minutes. That process was cut, he said.
The biggest changes involved changing the culture of the emergency department, Britton and Hart said.
Nurses may now provide a bed to someone who arrived in an ambulance rather than admitting a patient who’s been waiting in the emergency room, Britton said. That’s because a person in a waiting room may have already seen a doctor and be awaiting further treatment, while a patient in an ambulance has not.
San Joaquin County, for the last eight years, has practiced a protocol in which patients in ambulances get medical attention within 30 minutes — even if the patient is driven to a nearby county — with “zero negative patient outcomes,” said Assistant Chief Jon Rudnicki, the director for Emergency Medical Services for Metro Fire.
That practice followed the patient even in Sacramento. Nurses granted the patient a bed after 30 minutes if an ambulance from San Joaquin County arrived in Sacramento, Rudnicki said.
“This is unacceptable,” Rudnicki said. “If I want to be seen faster, gone are the days of just call 911 (and) get an ambulance. Go to San Joaquin and call an ambulance, and you will jump the line for a low acuity call.”
The drops in wait times come as ambulance traffic has not eased, according to hospitals. Ambulance visits typically drop as summer wanes, but this has not happened.
AB 40, authored by Assemblymember Freddie Rodriguez, D-Pomona, does not have any penalties associated with ensuring hospitals comply with the rules.
But hospitals, if their wait times don’t drop by Jan. 1, will have to answer to the state Emergency Medical Services Authority about why and plans to ensure compliance, Kann said.
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