Ambulance diversion ban eases ED crowding

Despite fears of emergency department backlogs, the first statewide ban on ambulance diversions led to shorter average ED wait time and ambulance turnaround time at nine Boston-area hospitals, HealthLeaders Media reported.

Even though overall ED traffic at the nine hospitals rose 3.6 percent after the diversion ban kicked in January 2009, length of stay dropped 10.4 minutes for admitted patients, while ambulance turnaround time decreased 2.2 minutes, according to a study in the December Annals of Emergency Medicine.

The study suggests that ambulance diversion has a minimal effect on ED crowding and also reinforces the notion that ED boarding is a main driver of overcrowding.

"If you want to impact crowding, ambulance diversion isn't the best way to go about it. Hospital-wide factors such as lack of bed availability or insufficient staffing cause boarding in the ED, which is a much greater contributor to crowding," study coauthor Laura G. Burke, an emergency physician at Boston's Beth Israel Deaconess Medical Center, told HealthLeaders.

Moreover, operational changes to improve patient flow through the entire hospital helped mitigate crowded emergency departments, such as streamlining physician and nurse handoff for admitted patients and reducing the target hospital occupancy level, the study found.

Crowded emergency departments are associated with increased inpatient mortality and moderate rises in length of stay and costs, according to another December study in the Annals of Emergency Medicine.

To learn more:
- read the HealthLeaders article
- check out the first study (.pdf)
- here's the second  study (.pdf)