The effect of a zero-diversion policy on emergency department performance measures

Abstract

This study examines how emergency department (ED) performance measures at an academic tertiary care center in the Midwest were affected by a regionally-adopted zero diversion policy.Two six-month periods before and after the policy was enacted were selected to measure differences in key performance measures, including left without treatment (LWOT), left without being seen (LWBS), left against medical advice (AMA), mortality, length of stay and hospital admission rate.Total ED census during the two periods was similar. While the zero diversion policy was in effect, LWOT and LWBS rates were 19.4% and 18.2% lower, respectively, than the prior period, p < .002; discharged patients had faster treatment times (228 + 8.0 minutes vs. 242 + 9.0 minutes), p = .015. No differences were observed in AMA or mortality rates. This study revealed no worsening of ED performance measures after adoption of a zero diversion policy.