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Tuesday | 1.16.2018
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Ambulance Diversion Strongly Linked with Increased Mortality of Heart Attack Patients

Diverting ambulances to more-distant emergency rooms when the closest one is jammed is taking its toll in death rates, a new study shows, and physicians are recommending solutions.

Lengthy periods of ambulance diversion are associated with higher mortality rates among patients with time-sensitive conditions, such as acute myocardial infarction, commonly known as a heart attack. When a patient’s nearest emergency department was on diversion for 12 or more hours, patient mortality rates were higher at 30 days, 90 days, nine months and one year than when not on diversion, according to the study, reported in the Journal of the American Medical Association.

The study of nearly 14,000 elderly patients indicates that ambulance diversion is a signal of a larger access problem in the healthcare system. Study authors said that ambulance diversion affects not only the patients who are diverted, but also non-diverted patients within the hospital that was on diversion.

Emergency rooms go on diversion because they are crowded with patients waiting for a bed in the hospital. And crowded ERs may struggle to care for all their patients.

“A task force of emergency physician experts have proposed solutions to crowding and ambulance diversion, and hospitals can implement them now,” said Dr. Sandra Schneider, president of the American College of Emergency Physicians (ACEP). “The key is increasing flow through emergency departments by moving patients who have been admitted to the hospital out the emergency department to inpatient areas.”

Among the task force recommendations are:

  • Move admitted patients out of the emergency department to inpatient areas (see full capacity protocol http://www.hospitalovercrowding.com). With each unit taking a small number of patients, the burden of boarding is more evenly spread, thus enabling the emergency department to better care for emergencies–without unduly stressing the inpatient units.
  • Coordinate the discharge of hospital patients before 12 noon. Research shows that timely departure from the hospital can significantly improve the flow of patients in emergency departments by making more inpatient beds available to emergency patients.

  • Coordinate the scheduling of elective patients and surgical cases. Studies demonstrate that the uneven influx of elective patients (heaviest early in the week) is a prime contributor to exceeding capacity. This often requires support services to be available seven days a week.

Study authors were unable to determine the precise mechanisms by which diversion affects patient outcomes, but found that when the nearest emergency department is on diversion, a lower proportion of patients are admitted to hospitals with catheterization capacity. They said the findings point to the need for targeted interventions to appropriately distribute system-level resources to decrease crowding and diversion.

ACEP is a national medical-specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.


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