Skip to main content
×
Home
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 2
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Xu, Kuang and Chan, Carri W. 2016. Using Future Information to Reduce Waiting Times in the Emergency Department via Diversion. Manufacturing & Service Operations Management, Vol. 18, Issue. 3, p. 314.


    Andronikof, M. Roche, V. Civadier, M. -S. Lalmas, A. Rechatin, B. and Chary, I. 2016. Évaluation d’un service d’urgence possédant une unité d’hospitalisation conventionnelle. Annales françaises de médecine d'urgence, Vol. 6, Issue. 2, p. 85.


    ×

Characteristics of Hospitals Diverting Ambulances in a California EMS System

  • Christopher A. Kahn (a1), Samuel J. Stratton (a2) and Craig L. Anderson (a3)
  • DOI: http://dx.doi.org/10.1017/S1049023X13009242
  • Published online: 22 January 2014
Abstract
AbstractIntroduction

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.

Copyright
Corresponding author
Correspondence: Christopher A. Kahn, MD, MPH 200 W. Arbor Drive, MC 8676 San Diego, CA 92103 USA E-mail ckahn@ucsd.edu
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2.CW Burt , LF McCaig , RH Valverde . Analysis of ambulance transports and diversions among US emergency departments. Ann Emerg Med. 2006;47(4):317-326.

3.DA Handel , JA Hilton , MJ Ward , E Rabin , FL Zwemer Jr., JM Pines . Emergency department throughput, crowding, and financial outcomes for hospitals. Acad Emerg Med. 2010;17(8):840-847.

4.PL Henneman , BH Nathanson , H Li , et al. Emergency department patients who stay more than 6 hours contribute to crowding. J Emerg Med. 2010;39(1):105-112.

5.NR Hoot , D Aronsky . Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126-136.

6.JS Olshaker , NK Rathlev . 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.

7.AJ Carter , R Grierson . The impact of ambulance diversion on EMS resource availability. Prehosp Emerg Care. 2007;11(4):421-426.

8.JC Pham , R Patel , MG Millin , TD Kirsch , A Chanmugam . The effects of ambulance diversion: a comprehensive review. Acad Emerg Med. 2006;13(11):1220-1227.

9.RM Williams . Ambulance diversion: economic and policy considerations. Ann Emerg Med. 2006;48(6):711-712.

11.RP Shenoi , L Ma , J Jones , M Frost , M Seo , CE Begley . 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.

12.CE Begley , Y Chang , RC Wood , A Weltge . Emergency department diversion and trauma mortality: evidence from Houston, Texas. J Trauma. 2004;57(6):1260-1265.

13.T Falvo , L Grove , R Stachura , W Zirkin . The financial impact of ambulance diversions and patient elopements. Acad Emerg Med. 2007;14(1):58-62.

14.DA Handel , K John McConnell . The financial impact of ambulance diversion on inpatient hospital revenues and profits. Acad Emerg Med. 2009;16(1):29-33.

15.KJ McConnell , CF Richards , M Daya , CC Weathers , RA Lowe . Ambulance diversion and lost hospital revenues. Ann Emerg Med. 2006;48(6):702-710.

17.KW Neely , RL Norton , GP Young . The effect of hospital resource unavailability and ambulance diversions on the EMS system. Prehosp Disaster Med. 1994;9(3):172-176; ; discussion 177.

18.JV Quinn , SV Mahadevan , G Eggers , H Ouyang , R Norris . Effects of implementing a rapid admission policy in the ED. Am J Emerg Med. 2007;25(5):559-563.

20.BC Sun , SA Mohanty , R Weiss , 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.

21.NR Hoot , LJ Leblanc , I Jones , et al. Forecasting emergency department crowding: a prospective, real-time evaluation. J Am Med Inform Assoc. 2009;16(3):338-345.

22.JS Olshaker . Managing emergency department overcrowding. Emerg Med Clin North Am. 2009;27(4):593-603, viii.

23.MJ Schull , K Lazier , M Vermeulen , S Mawhinney , LJ Morrison . Emergency department contributors to ambulance diversion: a quantitative analysis. Ann Emerg Med. 2003;41(4):467-476.

C Kahn , S Stratton , C Anderson . Characteristics of hospitals diverting ambulances in a California EMS system. Prehosp Disaster Med. 2014;29(1):1-5

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: