Meeting the need
Mass. ERs adjust to year-old anti-diversion policy
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.