TY - JOUR
T1 - The Effect of Hospital Resource Unavailability and Ambulance Diversions on the EMS System
AU - Neely, Keith W.
AU - Norton, Robert L.
N1 - Funding Information:
Acknowledgments The authors appreciate the support of the Multnomah County Office of Emergency Medical Services, and the training officers and dispatchers of AA Ambulance Service, Buck Medical Services, and Care Ambulance Service, and the data entry support of Ahmed Afzal.
PY - 1994/9
Y1 - 1994/9
N2 - Hypotheses: 1) There is no increase in transport or scene time of diverted patients and no increase in distances traveled; 2) hospital resource shortages bear no relationship to the number of patients diverted; and 3) paramedics are able to match their patient correctly with the resources available at a given hospital Methods: This was a five-month, prospective, observational study in an urban area with a population of 600,000 comparing all 9-1-1 ambulance diversions against a randomly selected sample of 5% of all other 9-1-1 originated patients. All patient diversions that originated from the 9-1-1 center are included in the study. Results: Hospitals identify their diversion star tus on a community-wide computer system monitored at the 9-1-1 center and base station. Accepted categories include: 1) diversion of all patients through the 9-1-1 center from the emergency department (ED); 2) trauma system patients (T); 3) psychiatric secure beds (PSB); 4) general acute ward beds (AW); 5) critical care (CC); 6) computed tomography scan (CT); 7) labor and delivery (LD); and 8) pediatric beds (PEDS). Data were abstracted from 481 patients’ records. A total of 111 were diverted from their intended destination. Transport times were longer and diverted patients traveled further (p >.002). Hospitals showing ED and LD diversion categories were more likely to have patients diverted away (r2 =.893, multilinear regression, p >.001). Of the 111 patients, 21 (19%) were diverted because of CC unavailability. Six of these (28%) were inappropriate because they did not fit the CC definition. Conclusions: In this system, hospital diversions increase transport times and distances traveled. Diversion of patients correlated strongly to unavailability of specific categories. Paramedics make errors in determining appropriate CC diversions. Systems reviewing their diversion problems need to assess the impact of longer out-of-hospital times and of certain diversion categories, and to clarify definitions.
AB - Hypotheses: 1) There is no increase in transport or scene time of diverted patients and no increase in distances traveled; 2) hospital resource shortages bear no relationship to the number of patients diverted; and 3) paramedics are able to match their patient correctly with the resources available at a given hospital Methods: This was a five-month, prospective, observational study in an urban area with a population of 600,000 comparing all 9-1-1 ambulance diversions against a randomly selected sample of 5% of all other 9-1-1 originated patients. All patient diversions that originated from the 9-1-1 center are included in the study. Results: Hospitals identify their diversion star tus on a community-wide computer system monitored at the 9-1-1 center and base station. Accepted categories include: 1) diversion of all patients through the 9-1-1 center from the emergency department (ED); 2) trauma system patients (T); 3) psychiatric secure beds (PSB); 4) general acute ward beds (AW); 5) critical care (CC); 6) computed tomography scan (CT); 7) labor and delivery (LD); and 8) pediatric beds (PEDS). Data were abstracted from 481 patients’ records. A total of 111 were diverted from their intended destination. Transport times were longer and diverted patients traveled further (p >.002). Hospitals showing ED and LD diversion categories were more likely to have patients diverted away (r2 =.893, multilinear regression, p >.001). Of the 111 patients, 21 (19%) were diverted because of CC unavailability. Six of these (28%) were inappropriate because they did not fit the CC definition. Conclusions: In this system, hospital diversions increase transport times and distances traveled. Diversion of patients correlated strongly to unavailability of specific categories. Paramedics make errors in determining appropriate CC diversions. Systems reviewing their diversion problems need to assess the impact of longer out-of-hospital times and of certain diversion categories, and to clarify definitions.
KW - ambulance diversions
KW - criucal care EMS system emergency department health maintenance organization (HMO) labor and deliver overcrowding psychiatry pediatrics resource unavailability trauma
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U2 - 10.1017/S1049023X00041297
DO - 10.1017/S1049023X00041297
M3 - Article
C2 - 10155524
AN - SCOPUS:0028475348
SN - 1049-023X
VL - 9
SP - 172
EP - 176
JO - Prehospital and Disaster Medicine
JF - Prehospital and Disaster Medicine
IS - 3
ER -