Guidelines for ambulance diversion

Brennan, John A.; Allin, Dennis; Calkins, Anne; Enguidanos, Enrique R.; Heimbach, Leah J.; Pruden, J.; Stilley, David G.

doi:10.1067/mem.2000.110815

Cited by 20 publications

(7 citation statements)

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“…The American College of Emergency Physicians (ACEP) has developed guidelines by which hospitals declare, and exist in, the state of diversion in order to minimize its negative effects (Brennan et al, 2000). We focus in the remainder of this section on research geared at understanding and reducing ambulance diversion to better accommodate patient arrivals.…”

Section: Ambulance Diversionmentioning

confidence: 99%

Operations research/management contributions to emergency department patient flow optimization: Review and research prospects

Saghafian

Austin

Traub

2015

IIE Transactions on Healthcare Systems Engineering

122

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In recent years, Operations Research/Management (OR/OM) has had a significant impact on improving the performance of hospital Emergency Departments (EDs). This includes improving a wide range of processes involving patient flow from the initial call to the ED through disposition, discharge home, or admission to the hospital. We review approximately 350 related papers to (i) demonstrate the influence of OR/OM in EDs, and (ii) assist both researchers and practitioners with the OR/OM techniques already available to optimize ED patient flow. In addition, we elaborate on some practical challenges yet to be addressed. By shedding light on some less studied aspects that can have significant impacts on ED operations, we also discuss important possibilities for future OR/OM researchers.

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Section: Ambulance Diversionmentioning

confidence: 99%

Operations research/management contributions to emergency department patient flow optimization: Review and research prospects

Saghafian

Austin

Traub

2015

IIE Transactions on Healthcare Systems Engineering

122

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“…For a multi-hospital system having more than three hospitals, the capacity of the hospitals was designed to reduce AD duration from a long-term perspective using linear programming [1], the centralized AD policies were evaluated using a genetic algorithm and simulation [29], and several heuristic AD rules were developed and verified through computer simulation [30,31]. In addition, according to the American College of Emergency Physicians (ACEP), each EMS system must develop a cooperative diversion policy designed to identify situations of hospital resources and to regularly review and update the hospital's diversion status [32].…”

Section: Introductionmentioning

confidence: 99%

“…One of the reasons for this is that it is not easy to identify the relation and impact of AD decisions between hospitals, because the complexity increases with the number of hospitals in the system. Therefore, we develop and evaluate a centralized AD policy in a multi-hospital system using the rolling-horizon optimization framework, which regularly reviews and updates the hospital's remaining capacity and diversion status; this is also included in the ACEP guidelines [32].…”

Section: Introductionmentioning

confidence: 99%

Centralized Ambulance Diversion Policy Using Rolling-Horizon Optimization Framework to Minimize Patient Tardiness

2020

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Ambulance diversion (AD) is a common method for reducing crowdedness of emergency departments by diverting ambulance-transported patients to a neighboring hospital. In a multi-hospital system, the AD of one hospital increases the neighboring hospital’s congestion. This should be carefully considered for minimizing patients’ tardiness in the entire multi-hospital system. Therefore, this paper proposes a centralized AD policy based on a rolling-horizon optimization framework. It is an iterative methodology for coping with uncertainty, which first solves the centralized optimization model formulated as a mixed-integer linear programming model at each discretized time, and then moves forward for the time interval reflecting the realized uncertainty. Furthermore, the decentralized optimization, decentralized priority, and No-AD models are presented for practical application, which can also show the impact of using the following three factors: centralization, mathematical model, and AD strategy. The numerical experiments conducted based on the historical data of Seoul, South Korea, for 2017, show that the centralized AD policy outperforms the other three policies by 30%, 37%, and 44%, respectively, and that all three factors contribute to reducing patients’ tardiness. The proposed policy yields an efficient centralized AD management strategy, which can improve the local healthcare system with active coordination between hospitals.

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“…Diversion of incoming patients remains one of the most widely used responses to ED overcrowding. [13][14][15] Sometimes it is impossible to divert, particularly in rural areas where a single ED serves the local population. Increasingly in major urban areas, diversions have become less successful at limiting new patients and have opened the door for criticism about diversion policies.…”

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confidence: 99%

When the Safety Net Is Unsafe Real‐time Assessment of the Overcrowded Emergency Department

Reeder

Garrison

2001

Academic Emergency Medicine

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Abstract. Although much work has been done evaluating causes for increased demand for emergency department (ED) services, few ways are available to help determine that an individual ED is overcrowded. Four calculations are proposed using real-time data for accurately diagnosing an ED with potential for failing both as a safety net and as a source for quality health care. The bed ratio (BR) accounts for the number of patients in relation to the available treatment spaces. The BR is obtained by adding the current number of ED patients to the predicted arrivals minus the predicted departures and dividing the result by the total number of treatment spaces. The acuity ratio (AR) measures the relative burden of illness in the ED. The AR is the average triage category of all patients in the ED. The provider ratio (PR) determines the volume of patients that can be evaluated and treated by the physician providers. The PR is found by dividing the arrivals per hour by the sum of the average patients per hour usually disposed for each provider on duty. From these ratios, the demand value (DV) is calculated, which gives an overall measure of current demand. The DV is found by taking the sum of the BR and PR and multiplying by the AR. A DV of more than 7 should initiate a specific assessment of the individual ratios in order to accurately diagnose the problem and institute action. Based on the values, predetermined processes can be instituted to help remedy the overcrowded situation. Trended over time, the ratios can provide the data needed for better resource assessment, planning, and allocation.

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Guidelines for ambulance diversion

Cited by 20 publications

References 0 publications

Operations research/management contributions to emergency department patient flow optimization: Review and research prospects

Operations research/management contributions to emergency department patient flow optimization: Review and research prospects

Centralized Ambulance Diversion Policy Using Rolling-Horizon Optimization Framework to Minimize Patient Tardiness

When the Safety Net Is Unsafe Real‐time Assessment of the Overcrowded Emergency Department

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