Massachusetts orders hospital EDs to halt ambulance diversions

In an unusual step, Massachusetts officials have ordered the state's hospitals to stop re-routing ambulances to other hospitals when their emergency departments become overcrowded. Officials at the state's Department of Public Health are mandating that hospitals will have to discontinue diversions in nearly every case by Jan. 1, 2009. After that date, hospitals will be allowed to close their EDs to ambulances only if they have a serious internal emergency such as a major fire.

This rule will have perhaps the biggest impact on Massachusetts General and Brigham and Women's hospitals in Boston, which account for most of the diversions in the state. Massachusetts General, which sees about 85,000 patients per year in its ED, accounted for 35 percent of the 1,826 hours hospitals closed EDs to ambulances last year. That equates to its ED being closed for almost month.

The agency argues that while diversions may give hospitals a brief chance to catch up, it does nothing to address the underlying problem of patients boarding in the hallways because hospitals lack open beds. Actually, officials say, diversions cause other significant problems, including increasing the time patients spend in ambulances, tying up the vehicles and shifting crowding to other facilities.

Early evidence suggests that despite the scope of the problem, area hospitals can cope, believe it or not. Dr. Brien Barnewolt, chairman of emergency medicine at Tufts Medical Center in Boston, told the Boston Globe that Boston hospitals stopped ED closures for two weeks as an experiment, and that there was no increase in time to see patients, or in patients boarding in ED hallways. Instead, hospitals found ways to treat patients more quickly and get them into beds as needed, he said.

To learn more about this plan:
- read this piece from The Boston Globe

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