Halting ambulance diversions didn't affect ED waits

[Guest guest]

Halting ambulance diversions didn't affect ED waits

Massachusetts hospitals adjusted to possible overcrowding by adopting

strategies to improve patient flow, experts find. Emergency doctors say

other states should pursue the policy.

By B. O'Reilly, amednews staff. Posted Jan. 25, 2010.

A Massachusetts ban on ambulance diversion that took effect in 2009 has not

worsened wait times in the state's emergency departments.

Since the health department regulation, believed to be the first statewide

ban on ambulance diversion in the U.S., took effect Jan. 1, 2009, 73

hospitals have reported the time from patient arrival in the ED to

disposition. Through September 2009, ED patients admitted to Massachusetts

hospitals spent about 5½ hours in the emergency department. Patients who

were not admitted spent 2½ hours receiving treatment in the ED, according to

state data shared with American Medical News.

The ED wait times were largely unchanged from the first month of reporting

in January 2009 through the last month of reporting in September 2009.

The Massachusetts College of Emergency Physicians pushed for the ban on

ambulance diversion, which is the practice of referring ambulance-driven

patients elsewhere because a hospital's emergency department has hit

capacity. The organization's president, ph M. Bergen, DO, said the

health department's data show that the policy appears to have worked well,

despite trepidations.

" There were concerns that we would see ambulances stacked up and unable to

unload patients and that emergency departments would become even more

crowded with even poorer flow numbers, " said Dr. Bergen, chair of emergency

medicine at Emerson Hospital in Concord, Mass. " We have not, to my

knowledge, had any major patient care problems as a result of this action,

and I submit that most emergency directors would say quite the opposite --

that patient care has improved, because patients are going to the

appropriate hospital, where the specialists know them and where their

medical records are stored. "

Hospitals have made administrative changes to improve patient flow, said

, RN, senior vice president of clinical affairs at the

Massachusetts Hospital Assn. Examples include discharging inpatients before

noon, adjusting ED staffing, adding overflow units, streamlining admissions

and changing elective surgery times.

" Overall, our hospitals are now addressing emergency department overcrowding

and diversion as a facilitywide issue, not just an ED issue, " said.

Avoiding diversion

The ambulance diversion ban did not come suddenly. A state task force with

representation from physicians, hospitals and others had been working on the

issue, and many hospitals in the state already had adopted internal

no-diversion policies.

" Many hospitals already were doing a lot of work on patient flow, " said

Daake, MPH, director of policy development, planning and research

for the Bureau of Health Care, Safety and Quality in the Massachusetts Dept.

of Public Health. " It is due to the hard work of everyone involved, from

policymakers to hospitals themselves to ambulance workers, that [wait times]

have stayed so reasonable. "

Every minute an ambulance is diverted. The state's diversion task force is

now focusing on ED patient boarding and patient flow, Daake said. Under the

regulation, hospitals are still allowed to divert ambulances in the event of

facility problems such as loss of electrical power. Daake said health

officials from around the country have inquired about adopting the Bay

State's policy.

Nationally, one ambulance is diverted every minute, according to the

American College of Emergency Physicians. At any moment, one in 10 hospitals

is on diversion, said Schneider, MD, ACEP's president-elect. She said

she hopes other states take a tougher line on diversion.

" What I think you're going to see out of [the Massachusetts experience], and

what I hope people will begin to understand, is that using the emergency

department as an overflow unit for the hospital is dangerous, " said Dr.

Schneider, professor of emergency medicine at the University of Rochester

School of Medicine and Dentistry in New York.

" The bottom line is about what's good for the patients, " she said. " In

Massachusetts, we've seen that they decided to look at what was good for the

patient and that means no ambulance diversion and asking, 'How do we get

there?' I give them an amazing amount of credit -- they have done the right

thing for people. "

This content was published online only.

Randy E. RN, LP