Ambulances

Massachusetts orders hospital EDs to halt ambulance diversions

Anne Zieger — Tue, 16 Sep 2008 13:05:41 -0400

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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Case study: TX trauma hospital faces neurosurgery crisis

Fri, 09 May 2008 06:59:54 -0400

In a situation echoed in emergency departments around the country, the ED at Harris Methodist Fort Worth Hospital has been turning away patients with brain and spine injuries for months due to a shortage of neurosurgeons. Worse, the neurosurgeons who remain have been threatening to leave, tired of being overworked because of the shortage. Harris would like to recruit as many as five additional neurosurgeons, but national shortages have made this extremely difficult.

The hospital, a level 2 trauma center, has just four neurosurgeons available, covering every other day. Right now, ambulances must frequently take those with serious injuries to publicly-funded John Peter Smith, which is nearby. The neurosurgeons at JPS have seen their workload grow 84 percent, to 794 consultations last year. Meanwhile, the number of trauma patients admitted to Harris dropped 7 percent from 2006 to 2007.

To learn more about Harris' issues:
- read this Fort Worth Star-Telegram article

Related Article:
Trend: On-call shortage closing trauma departments

WA hospitals struggle with extreme ED overloads

Mon, 24 Mar 2008 07:59:56 -0400

While emergency departments are overloaded across the U.S., few regions are struggling quite as hard as Washington state's King County area, where overflowing facilities are closing EDs as often as six times a month, according to area officials. The problem seems to be a more-intense version of issues that are cropping up nationally, including a flood of uninsured patients, a primary-care physician shortage and an aging population, and an unusual influx of patients with winter illnesses like the flu. No one is sure why things are quite so bad now, but this is about the worst even the most experienced veterans in the region have seen, according to a report in the Seattle Times. This summer, hospitals hope to get some help in the form of a new system that routes ambulances around the county more efficiently. Also, one of the area's trauma hospitals plans to open 50 beds. However, it seems the region will remain in crisis for while unless bed supply increases further--or patient influx slows down.

To learn more about the Puget Sound area's hospital crisis:
- read this Seattle Times piece

Related Articles:
CDC report backs emergency department overcrowding charges. Report
Hospitals develop strategies to cope with ED overloads. Editorial
Overcrowding worsens at nation's EDs. Report
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