Coordinated Ambulance Diversion Improves Care

A recent study found a significant decrease in diversion of ambulances away from crowded EDs, despite an increase in transportation of patients by ambulance, following a community-wide effort to coordinate ambulance transportation in San Diego County in California.

The two-year study examined the use of standardized rules across 21 hospitals to allow more patients to be transported to their hospital of choice, which helped eliminate delays in obtaining medical records and having to transfer admitted patients to comply with health plan standards.

"Our standard operation has always been to ask patients where they prefer to go, so that practice didn't change for the study," says Gary M. Vilke, MD, medical director and the study's lead author from the University of California, San Diego. "In the past, however, if a patient requested a hospital that was on bypass, they went to the next facility that was not on diversion. With the study, we worked out a system so a hospital that was on diversion didn't get any patients who did not specifically request that facility, but they would take their own patients.

"As an emergency physician, if I receive a patient who was discharged two days earlier after a complex procedure in a hospital across town, I spend a lot of time trying to figure out what happened, where his records are and who his doctor is, and then try to get him transferred back to that facility. Everybody agrees that patients are best served by going to their own facility, and we all felt this was the appropriate thing to do. Once we got that mind frame going, it just served itself. If you get hospitals to participate, theoretically, this can work anywhere."

The study concluded that coordination and transportation of patients to requested emergency departments is an important step toward easing the burden of overcrowding because it results in more efficient use of patient beds, greater access to patient medical records and improved continuity of patient care, says Vilke, who presented the study's findings during the October meeting of the American College of Emergency Physicians in Boston. An abstract of the study was published in the October issue of Annals of Emergency Medicine.

Anyone interested in more information is welcome to contact Vilke by e-mail at: gmvilke@ucsd.edu.

-MN