Diversion hours were 39% lower last year

Last year diversion hours at Community General's emergency department (ED) fell from an average of 6.9 hours per day (2007) to 4.4 hours (2008). That’s a reduction of 39%. And things were better during the fourth quarter when Community's diversion hours dropped from an average 8.5 hours a day to 2.2 hours, a 74% decline.

Syracuse hospitals generally did a better job last year of providing access to emergency care. Collectively the four non-federal hospitals reduced diversion hours by 10% in 2008 -- and by 57% in the fourth quarter.

When a hospital is “on diversion,” its emergency department asks ambulances to “divert” emergency patients elsewhere. If all Syracuse hospitals happen to be on diversion simultaneously, then the emergency medical system (EMS) directs ambulances to each hospital in sequence.

Diversion occurs when there is an imbalance between patient demand and hospital capacity. If too many patients seek care for the size of an ED or its staff, a hospital may request diversion until a balance is restored. Sometimes an internal event (for example, water line break) may prompt diversion status.

When hospitals are on diversion, a patient seeking care at one hospital may end up at another, at a place where her doctors are not available and where her medical records are not at hand. That’s why the American College of Emergency Physicians, among others, has guidelines for ambulance diversion.

Even when on diversion, however, a hospital's ED is not actually closed. Every emergency department will accept a patient who presents herself for emergency care at any time. A patient has the right to insist that an ambulance go to the hospital of her choice, irrespective of diversion status.

Through the Hospital Executive Council (HEC), a planning agency, Syracuse hospitals have worked together to understand and reduce diversion hours. Funded by the hospitals, the HEC shares data, conducts analyses, and helps support cooperative initiatives to improve health care efficiency and quality.

Diversion is not only about emergency department issues. Does a patient remain in the ED longer than necessary while waiting for a hospital bed to become available? Is a hospital’s length of stay extended because of delays in tests or test reports, because of the time it takes to prepare a room for the next patient, or because patients cannot readily be transferred to nursing homes? Diversion is an indicator of the flow and efficiency of, not just a hospital, but of the health care system within a community.

Here’s an interesting note: last month Massachusetts ordered hospitals to stop diversion, except in specific cases. Syracuse hospitals have reduced, but not eliminated, diversion hours, and we’ve done so voluntarily and cooperatively.

It will be interesting to see the experience of Massachusetts with its regulatory approach.