Ambulance diversion: Reduced hours, total bans may improve ER crowding

Though efforts to minimize ambulance diversion at some facilities have created positive outcomes, there is still progress to be made and questions to answer, according to a policy brief published in Health Affairs.

As recently as 2003, 45 percent of emergency departments went on diversion status, a move seen more as an emergency measure for overcrowded emergency rooms than a solution to the problem, according to the brief. In the short term, it is an effective way to allow an ED to clear space as it handles an overflow of patients, but it can cause a domino effect that leads surrounding hospitals to also divert ambulances, according to the brief.

To minimize ambulance diversion, some ERs have enforced policies that limit the amount of time in a day where they can invoke diversion status, or have banned the practice outright, according to the policy brief.  The policy brief cited the 2009 decision in Massachusetts to ban ambulance diversion statewide. After eliminating the practice, hospitals in the Boston area saw the length of stay in the ED for admitted patients fall by more than 10 minutes, and discharged patients did not experience more time in the ER. Hospitals in the state, hired extra staff, increased rounds at inpatient beds, created an inpatient "surge pod" for those being processed in the ED and identified a group of clinicians to deploy when staff was shorthanded, the brief said.

For hospitals looking to cut back on ambulance diversion, the Health Affairs brief notes it is a symptom of the larger problem of ED overcrowding, and that merely focusing on diversion will not solve the issue. Approaching both issues as one, and improving communication between regional health facilities will see greater success, according to the brief.

To learn more:
- read the policy brief