The Effect of an Ambulance Diversion Ban on Emergency Department Length of Stay and Ambulance Turnaround Time

Burke, Laura; Joyce, Nina R.; Baker, William E.; Biddinger, Paul D.; Dyer, K. Sophia; Friedman, Franklin D.; Imperato, Jason; King, A. J.; Maciejko, Thomas; Pearlmutter, Mark; Sayah, Assaad; Zane, Richard D.; Epstein, Stephen K.

doi:10.1016/j.annemergmed.2012.09.009

Cited by 32 publications

(22 citation statements)

References 19 publications

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“…In fact, hospitals with high diversion rates actually had a decreased LOS for discharged patients, although not statistically significant. Like our study, these studies suggest that a diversion ban does not necessarily lead to ED overcrowding [15,17] . However, Burke et al was able to point to concrete interventions that were made by hospitals in changes to practice such as inpatient bed rounds twice a day to decompress the ED, reduction in target hospital occupancy level, and prioritization of inpatient bed assignments, to name a few.…”

Section: Discussionmentioning

confidence: 49%

“…the practice of holding or "boarding" admitted patients in the ED for several hours to days because of decreased inpatient capacity). Diversion, on the other hand, is an input factor, and has not been proven to relieve ED congestion and has been theorized to be less important of a factor [15] . Ultimately, evidence for or against diversion is limited at best, and we believed there would be no statistical difference in emergency department performance measures and outcomes between diversion and no-diversion.…”

Section: Discussionmentioning

confidence: 99%

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

Spaulding

Byrne

Armbrecht

et al. 2013

JHA

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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.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

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

Spaulding

Byrne

Armbrecht

et al. 2013

JHA

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“…24 Banning ambulance diversion from hospitals reduces ED LOS and ambulance turnaround time. 25 Real-time information systems and process redesign in the ED reduce ED transit times and expedite early assessment, 26 as does the rapid response of inpatient teams to ED requests for review and admission. 27 …”

Section: Relationship Of Findings To Other Studiesmentioning

confidence: 99%

Aiming to be NEAT: safely improving and sustaining access to emergency care in a tertiary referral hospital

Sullivan¹,

Staib²,

Flores³

et al. 2014

Aust. Health Review

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Objective. To implement and evaluate strategies for improving access to emergency department (ED) care in a tertiary hospital.Methods. A retrospective pre-post intervention study using routinely collected data involving all patients presenting acutely to the ED of a major tertiary hospital over a 2-year period. Main outcome measures were changes in: the percentage of patients exiting the ED (all patients, patients discharged directly from the ED, patients admitted to inpatient wards); mean patient transit times in the ED; inpatient mortality rates; rates of ED 'did not wait' and re-presentations within 48 h of ED discharge; and selected safety indicators. Qualitative data on staff perceptions of interventions were also gathered.Results. Working groups focused on ED internal processes, ED-inpatient unit interface, hospital-wide discharge processes and performance monitoring and feedback. Twenty-five different reforms were enacted over a 9-month period from April to December 2012. Comparing the baseline period (January-March 2012) with the post-reform period (January-March 2013), the percentage of patients exiting the ED within 4 h rose for all patients presenting to the ED (from 32% to 62%), for patients discharged directly from the ED (from 41% to 75%) and for admitted patients (from 12% to 32%; P < 0.001 for all comparisons). The mean (AEs.d.) time all patients spent in the ED was reduced from 7.2 AE 5.8 to 4.4 AE 3.5 h (P < 0.001) and, for admitted patients, was associated with reduced in-hospital mortality (from 2.3% to 1.7%; P = 0.045). The 'did not wait' rates in ED fell from 6.9% to 1.9% (P < 0.001), whereas ED re-presentations within 48 h among patients discharged from the ED rose slightly (from 3.1% to 3.8%; P = 0.023). Improvements in outcome measures were maintained over the subsequent 12 months.Conclusions. Multiple reforms targeting processes both within the ED and its interface with inpatient units greatly improved access to ED care over 12 months and were associated with decreased in-hospital mortality.What is known about this topic? Prolonged stays in the ED result in overcrowding, delayed ambulance access to ED care and increased adverse outcomes for admitted patients. The introduction in Australia of National Emergency Access Targets (NEAT), which stipulate at least 70% of patients in the ED must exit the department within 4 h, have spurred hospitals into implementing a wide range of reforms with varying levels of success in achieving such targets. What does this paper add? This study demonstrates how multiple reforms implemented in a poor performing tertiary hospital caused the proportion of patients exiting the ED within 4 h to double within 9 months to reach levels comparable with best performing peer hospitals. This was associated with a 26% reduction in in-hospital mortality for admitted patients and no clinically significant adverse effects. It demonstrates the importance of robust governance structures, executive sponsorship, cross-disciplinary collaboration, regular feedback of N...

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“…Following a pilot study that concluded that diversion did not alleviate ED crowding, the state of Massachusetts eliminated diversion altogether in 2009. This resulted in reduced ambulance transportation times and ED length of stay [11].…”

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confidence: 99%

“…Rathlev et al [13] found no clinically significant changes in any ED group in mean monthly volume, admissions, elopements, or length of stay for any patient disposition group after implementation of the "No Diversion" moratorium. Burke et al [11] reported that the first statewide ambulance diversion ban in Massachusetts did not worsen ED crowding or ambulance availability and showed no increase in ED length of stay or ambulance turnaround time at Boston-area hospitals.…”

mentioning

confidence: 99%

Editorial: Ambulance Diversion: the Con Perspective

Nakajima

Vilke

2015

The American Journal of Emergency Medicine

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The Effect of an Ambulance Diversion Ban on Emergency Department Length of Stay and Ambulance Turnaround Time

Cited by 32 publications

References 19 publications

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

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

Aiming to be NEAT: safely improving and sustaining access to emergency care in a tertiary referral hospital

Editorial: Ambulance Diversion: the Con Perspective

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