ER overcrowding fallout: Ambulance diversion increases one-year mortality rates

When emergency departments (EDs) divert incoming ambulances due to overcrowding, one-year mortality rates increase while access to cardiac care falls, according to a study published in Health Affairs.

Researchers analyzed Medicare claims and daily ambulance diversion logs from 26 California counties over a 10-year period, looking at how different levels of diversion affected access, outcomes and treatment for acute myocardial infarction patients. They found significant ambulance diversions from the patients' closest facilities significantly reduced access to cardiac technology and increased the likelihood of one-year mortality nearly 10 percent compared to patients who did not have to deal with diversion.

The findings indicate that hospital leaders must consider interventions to manage the potential consequences of ambulance diversion, the authors wrote. To be truly effective, however, these policies would have to address the resource limitations that cause the diversion, according to the study. For example, in Houston, Ben Taub Hospital had to divert critical patients from the ED about 60 percent of the time in 2013, according to the Houston Chronicle.

If no meaningful solutions to overcrowding are feasible, according to the study, leaders must prioritize access for time-sensitive conditions requiring high-tech interventions, such as trauma or acute strokes.

Other areas have explored different solutions to the problem. For example, in Anaheim, California, where the fire department receives about 26,300 calls for medical assistance a year, officials have created a pilot program in which nurse practitioners join the paramedics responding to such calls, according to USA Today. Todd Newton, regional chief of emergency medicine at Kaiser Permanente, told the publication the program could be a solution to ED overcrowding and also provide patients with better care.

Reno, Nevada has implemented a similar program, saving the city $5.5 million in 2013 and 2014, FierceHealthcare previously reported. And in 2013, nine Boston-area hospitals outright banned ambulance diversion, cutting length of stay 10.4 minutes even as ED traffic rose 3.6 percent.

"[Patients] don't have to come in. They don't have to wait. They are being treated in a comfortable setting. It opens up our beds for people who really need them," Newton told USA Today. "Everybody wins."

To learn more:
- read the study abstract
- here's the Chronicle article
- check out the USA Today article