APOT Time Interval

The Ambulance Patient Offload Time (APOT) represents the total elapsed time between when an ambulance arrives at a hospital emergency department and when patient care is formally received by hospital staff. This metric is standardized statewide to measure emergency department offload efficiency.

Start of Measurement — Arrival at Destination Facility

• Event: The ambulance arrives at the hospital to begin patient offload.
• NEMSIS Field: eTimes.11 – Patient Arrived at Destination Date/Time
• Description: Timestamp when the ambulance reaches the emergency department and the patient is available for hospital evaluation (e.g., wheels stop at ED ambulance bay or crew enters receiving facility/care area). 
• Method: This datapoint may be established by ePCR button push or via a Computer-Aided Dispatch (CAD ) integration. CADs may record the ambulance arrival at an ED through GPS-triggered processes.

Receiving Facility Signature Time

• Event: The standardized transfer of patient care is completed when: 
  • The patient is physically transferred to a receiving facility gurney, bed, chair, or other mutually agreed upon and safe location 
  • AND EMS personnel provide a patient-centered verbal patient report to the receiving facility medical personnel 
  • AND Receiving facility medical personnel sign the ePCR and assume patient care 
• NEMSIS Field: eOther.19 –  The date/time the Signature of Person Receiving Patient Care signature was captured
• Description: When an ambulance patient is physically transferred to an emergency department gurney, bed, chair, or other acceptable location, and emergency department medical personnel receives the report and confirms the transfer of patient care with an electronic signature within the ePCR
• Relationship to eTimes.12:
  • The signature time typically corresponds to the eTimes.12 timestamp and may be used to validate the overall Transfer of Care interval.
  • For compliance and auditing purposes, eTimes.12 should reflect the time the receiving signature timestamp recorded in the ePCR or LEMSIS.
  • Discrepancies between eTimes.12 and the signature time should be minimal.

End of Measurement — Transfer of Care

• Event: The receiving hospital staff has received the formal transfer of patient care.
• NEMSIS Field: eTimes.12 – Destination Patient Transfer of Care Date/Time
• Description: Timestamp representing the moment of official patient handoff to hospital personnel. This marks the end of the offload interval.
• Method: This data is recorded in the ePCR through a date/time field. In the LEMSIS PCR, the field is named Destination Patient Transfer of Care Date/Time (including Transport Rendezvous/LZ). This field appears directly below the Receiving Facility Signature data group.

Under AB 40 and the related regulations, each civilian General Acute Care Hospital (GACH) with an emergency department can validate and reconcile APOT data using a statewide electronic Audit Tool. The aim is to ensure accuracy in measuring transfer-of-care times (NEMSIS eTimes.11 → eTimes.12) and to identify system or workflow barriers that cause delays in offloads.

Data Submission and Audit Timeframes

Monthly Submission:

• EMS transport providers submit APOT data through the California EMS Information System (CEMSIS) automatically via LEMSIS.
• EMS transport providers not in compliance with Health and Safety Code Section 1797.223 are excluded from the APOT data.

Hospital Audit Process and Timeframe:

• Hospital administrators review APOT data provided by the EMSA Audit Tool and identify any discrepancies, including those between electronic health record (EHR) or other administrative tracking system timestamps and CEMSIS-reported times.
• The APOT Audit Tool aims to improve the accuracy and confidence in EMS APOT data for EMS providers, LEMSAs, and hospitals. 
• EMSA recommends that hospital staff focus on APOT records that are most likely to impact the facility's APOT compliance metric, rather than reviewing all records.

Discrepancy Notification:

• Once hospital administrators submit any discrepancies through the monthly APOT Audit Tool, automated email notifications are sent to County EMS and the involved EMS provider(s) regarding any data mismatches. 
• EMS Agencies will receive a list of flagged PCR numbers by email. LEMSIS users may wish to use the LEMSIS EMS Incident System View PCR # Audit Tool to find the PCRs included in this notification. 
• EMS Agencies with records included in an audit, beginning October 14, 2025, may receive Audit Tool comments and other information through these automated notifications.