Date of Graduation

Fall 12-15-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Psychiatric Mental Health Nurse Practitioner

First Advisor

Dr. Trinette Radasa

Second Advisor

Dr. Susan Mortell




Ambulance delays in hospital EDs have recently been significant in the United States. This delay has been attributed to emergency department overcrowding, a record number of 911 calls, a shortage of ED staff (doctors and nurses), and poor resources available in the communities as alternatives to an ED visit. Local Emergency Medical Service Authorities (LEMSA) monitor and determine the community standards for measuring ambulance offload delays (AOD), usually in minutes.


Lengthy ambulance patient offload times and their subsequent impact on EMS have been significant all around the state of California as well as nationwide. The ambulance delay problem in California is at the point that the state government is working to reduce the delay through the legislature. An assembly bill known as AB 40, authored by Assemblymember Freddie Rodriguez (D-Pomona), has officially been signed into law by Governor Newsom. AB 40 would require the California Emergency Medical Services Authority (EMSA) to take urgent actions to address the chronic issue of AOD and implement standards to ensure all Californians receive immediate care when faced with life-threatening emergencies. The Psychiatric Emergency Services/Crisis Stabilization Unit (PES/CSU) in this project is an acute care psychiatric hospital in Alameda County (Northern California) plagued by long delays of up to 48 minutes of ambulance offload delays and up to 77 minutes at the 90th percentile for transfer of care. Under the provisions of AB 40, the Local Emergency Medical Services Authority (LEMSAs) in California will be required to maintain an APOT of 30 minutes or less.


This project seeks to implement the Fast-Track triage process to reduce the average Ambulance Patient Offload Time (APOT) to Alameda County Local EMS Authority set community standard of 30 minutes.

Proposed Measures.

For six months of the Fast-Track triage process implementation, psychiatric emergency services (PES) nurses at this project hospital will be trained on the Fast-Track triage process; APOT data will be collected every shift and collated monthly to assess the intervention’s progress. The impact of this process will be evaluated for effectiveness at the end of the six months. The PES nurses will also be surveyed on their knowledge, satisfaction, perceived bottlenecks with the Fast-Track triage process, and their observed impact on APOT.

Keywords: PES (psychiatric emergency services), APOT (ambulance patient offload time), APOD (ambulance patient offload delay), EMS (emergency medical services), triage, ambulance offload delays (AOD), hospital throughput.