Meet­ing the need

Mass. ERs ad­just to year-old anti-di­ver­sion pol­icy

Modern Healthcare - - The Week In Healthcare - Gregg Blesch

Nearly a year ago, the state of Mas­sachusetts ended the prac­tice of hos­pi­tals di­vert­ing am­bu­lances from crowded emer­gency rooms. So far hos­pi­tals seem to have ad­justed, even as vol­ume steadily in­creased as a re­sult of res­i­dents newly in­sured un­der the state’s uni­ver­sal health plan and spiked with the first wave of H1N1 flu cases and fears.

“Di­ver­sion is at best a stop­gap so­lu­tion for hos­pi­tals, and it’s not good for pa­tients,” said Stephen Ep­stein, an emer­gency physi­cian at 621-bed Beth Is­rael Dea­coness Med­i­cal Cen­ter in Bos­ton, speak­ing on be­half of the Amer­i­can Col­lege of Emer­gency Physi­cians. Ep­stein served on a task force the state es­tab­lished on the is­sue in 1999 and made the rec­om­men­da­tion in 2008.

“There was great con­cern and much fear amongst my­self and my col­leagues,” Ep­stein said. “What would hap­pen if we elim­i­nated di­ver­sion, and hos­pi­tals didn’t step up to the plate? All of a sud­den emer­gency rooms get over­whelmed and can’t turn off the flow.”

Hos­pi­tals ap­par­ently did step up to the plate. Data col­lected by the Mas­sachusetts Pub­lic Health Depart­ment in­di­cate that even though most ERs saw more pa­tients, the length of time those pa­tients waited to be ad­mit­ted or dis­charged at the vast ma­jor­ity of hos­pi­tals re­mained level or de­creased.

The num­bers do not show how those waits com­pare with pre­vi­ous years, only since the pol­icy was adopted. “We’re try­ing to come up with a real an­swer to that ques­tion,” Ep­stein said.

Karen Nel­son, se­nior vice pres­i­dent for clin­i­cal af­fairs for the Mas­sachusetts Hospi­tal As­so­ci­a­tion, said in a writ­ten state­ment that its mem­bers have used a va­ri­ety of ap­proaches to ad­just to loss of di­ver­sion as a release valve. They in­clude co­or­di­nat­ing elec­tive surgery to avoid ER peaks, mov­ing dis­charge times to morn­ings and cre­at­ing over­flow units.

“Over­all, our hos­pi­tals are now ad­dress­ing emer­gency depart­ment over­crowd­ing and di­ver­sion as a fa­cil­i­ty­wide is­sue, not just an ED is­sue,” Nel­son said.

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