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Characteristics of Hospitals Diverting Ambulances in a California EMS System

Published online by Cambridge University Press:  22 January 2014

Christopher A. Kahn ,
Samuel J. Stratton  and
Craig L. Anderson
Christopher A. Kahn*
Affiliation:
Department of Emergency Medicine, University of California, San Diego, California USA
Samuel J. Stratton
Affiliation:
Health Disaster Management/ Emergency Medical Services, Orange County Health Care Agency, UCLA School of Public Health and David Geffen School of Medicine at UCLA, Los Angeles, California USA
Craig L. Anderson
Affiliation:
Center for Trauma and Injury Prevention Research, Department of Emergency Medicine, University of California, Irvine, California USA
*
Correspondence: Christopher A. Kahn, MD, MPH 200 W. Arbor Drive, MC 8676 San Diego, CA 92103 USA E-mail [email protected]
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Abstract

Introduction

While several reports discuss controversies regarding ambulance diversion from acute care hospitals and the mortality, financial, and resource effects, there is scant literature related to the effect of hospital characteristics.

Hypothesis/Problem

The objective of this study was to describe specific paramedic receiving center characteristics that are associated with ambulance diversion rates in an Emergency Medical Services system.

Methods

A retrospective observational study design was used. The study was performed in a suburban EMS system with 27 paramedic receiving centers studied; one additional hospital present at the beginning of the study period (2000-2008) was excluded due to lack of recent data. Hospital-level and population-level characteristics were gathered, including diversion rate (hours on diversion/total hours open), for-profit status, number of specialty services (including trauma, burn, cardiovascular surgery, renal transplant services, cardiac catheterization capability [both interventional and diagnostic], and burn surgery), average inpatient bed occupancy rate (total patient days/licensed bed days), annual emergency department (ED) volume (patients per year), ED admission rate (percent of ED patients admitted), and percent of patients leaving without being seen. Demographic characteristics included percent of persons in each hospital's immediate census tract below the 100% and 200% poverty lines (each considered separately), and population density within the census tract. Bivariate and regression analyses were performed.

Results

Diversion rates for the 27 centers ranged from 0.3%-14.5% (median 4.5%). Average inpatient bed occupancy rate and presence of specialty services were correlated with an increase in diversion rate; occupancy rate showed a 0.08% increase in diversion hours per 1% increase in occupancy rate (95% CI, 0.01%-0.16%), and hospitals with specialty services had, on average, a 4.1% higher diversion rate than other hospitals (95% CI, 1.6%-6.7%). Other characteristics did not show a statistically significant effect. When a regression was performed, only the presence of specialty services was related to the ambulance diversion rate.

Conclusions

Hospitals in this study providing specialty services were more likely to have higher diversion rates. This may result in increased difficulty getting patients requiring specialty care to centers able to provide the needed level of service. Major limitations include the retrospective nature of the study, as well as reliance on multiple data systems.

KahnC , StrattonS , AndersonC . Characteristics of Hospitals Diverting Ambulances in a California EMS System. Prehosp Disaster Med. 2014;29(1):1-5.

Keywords

ambulanceEmergency Medical Serviceshospitaltransportation of patients
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 1 , February 2014 , pp. 27 - 31
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

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References

1. Future of Emergency Care: Emergency Medical Services At the Crossroads. National Academies Press, Washington, DC, 2006.Google Scholar
2. Burt, CW, McCaig, LF, Valverde, RH. Analysis of ambulance transports and diversions among US emergency departments. Ann Emerg Med. 2006;47(4):317-326.CrossRefGoogle ScholarPubMed
3. Handel, DA, Hilton, JA, Ward, MJ, Rabin, E, Zwemer, FL Jr., Pines, JM. Emergency department throughput, crowding, and financial outcomes for hospitals. Acad Emerg Med. 2010;17(8):840-847.CrossRefGoogle ScholarPubMed
4. Henneman, PL, Nathanson, BH, Li, H, et al. Emergency department patients who stay more than 6 hours contribute to crowding. J Emerg Med. 2010;39(1):105-112.CrossRefGoogle ScholarPubMed
5. Hoot, NR, Aronsky, D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126-136.CrossRefGoogle ScholarPubMed
6. Olshaker, JS, Rathlev, NK. Emergency Department overcrowding and ambulance diversion: the impact and potential solutions of extended boarding of admitted patients in the Emergency Department. J Emerg Med. 2006;30(3):351-356.CrossRefGoogle ScholarPubMed
7. Carter, AJ, Grierson, R. The impact of ambulance diversion on EMS resource availability. Prehosp Emerg Care. 2007;11(4):421-426.CrossRefGoogle ScholarPubMed
8. Pham, JC, Patel, R, Millin, MG, Kirsch, TD, Chanmugam, A. The effects of ambulance diversion: a comprehensive review. Acad Emerg Med. 2006;13(11):1220-1227.CrossRefGoogle ScholarPubMed
9. Williams, RM. Ambulance diversion: economic and policy considerations. Ann Emerg Med. 2006;48(6):711-712.CrossRefGoogle ScholarPubMed
10. Fatovich, DM. Effect of ambulance diversion on patient mortality: how access block can save your life. Med J Aust. 2005;183(11-12):672-673.CrossRefGoogle ScholarPubMed
11. Shenoi, RP, Ma, L, Jones, J, Frost, M, Seo, M, Begley, CE. Ambulance diversion as a proxy for emergency department crowding: the effect on pediatric mortality in a metropolitan area. Acad Emerg Med. 2009;16(2):116-123.CrossRefGoogle Scholar
12. Begley, CE, Chang, Y, Wood, RC, Weltge, A. Emergency department diversion and trauma mortality: evidence from Houston, Texas. J Trauma. 2004;57(6):1260-1265.CrossRefGoogle ScholarPubMed
13. Falvo, T, Grove, L, Stachura, R, Zirkin, W. The financial impact of ambulance diversions and patient elopements. Acad Emerg Med. 2007;14(1):58-62.CrossRefGoogle ScholarPubMed
14. Handel, DA, John McConnell, K. The financial impact of ambulance diversion on inpatient hospital revenues and profits. Acad Emerg Med. 2009;16(1):29-33.CrossRefGoogle ScholarPubMed
15. McConnell, KJ, Richards, CF, Daya, M, Weathers, CC, Lowe, RA. Ambulance diversion and lost hospital revenues. Ann Emerg Med. 2006;48(6):702-710.CrossRefGoogle ScholarPubMed
16. Burt, CW, McCaig, LF. Staffing, capacity, and ambulance diversion in emergency departments: United States, 2003-04. Adv Data. 2006 (376):1-23.Google Scholar
17. Neely, KW, Norton, RL, Young, GP. The effect of hospital resource unavailability and ambulance diversions on the EMS system. Prehosp Disaster Med. 1994;9(3):172-176; ; discussion 177.CrossRefGoogle ScholarPubMed
18. Quinn, JV, Mahadevan, SV, Eggers, G, Ouyang, H, Norris, R. Effects of implementing a rapid admission policy in the ED. Am J Emerg Med. 2007;25(5):559-563.CrossRefGoogle ScholarPubMed
19. Upfold, J. Emergency department overcrowding: ambulance diversion and the legal duty to care. CMAJ. 2002;166(4):445-446.Google ScholarPubMed
20. Sun, BC, Mohanty, SA, Weiss, R, et al. Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004. Ann Emerg Med. 2006;47(4):309-316.CrossRefGoogle ScholarPubMed
21. Hoot, NR, Leblanc, LJ, Jones, I, et al. Forecasting emergency department crowding: a prospective, real-time evaluation. J Am Med Inform Assoc. 2009;16(3):338-345.CrossRefGoogle ScholarPubMed
22. Olshaker, JS. Managing emergency department overcrowding. Emerg Med Clin North Am. 2009;27(4):593-603, viii.CrossRefGoogle ScholarPubMed
23. Schull, MJ, Lazier, K, Vermeulen, M, Mawhinney, S, Morrison, LJ. Emergency department contributors to ambulance diversion: a quantitative analysis. Ann Emerg Med. 2003;41(4):467-476.CrossRefGoogle ScholarPubMed