QUALITY: Ambulance Diversions Show Need for Reform (Part 1)

Whether you are rich or poor, insured or uninsured, a savvy "health care consumer" or a blithely not-so-savvy one doesn't matter if you are lying critically ill or injured on an ambulance gurney and the nearest ER is on "diversion"—meaning temporarily closed to ambulance traffic and sending patients elsewhere. Dr. Guy Clifton and Hannah Graff, two members of our health policy team, have published a new issue brief explaining what ambulance diversions are, why you should care, and what we should do about it. We'll share the highlights in three blog posts from today through Monday.

When an ambulance is diverted from one hospital emergency department and sent to another, critical care can be delayed by precious minutes. A threat to both the insured and uninsured populations, diversions are also a barometer of how badly our struggling health system needs comprehensive reforms. Diversions are not an occasional problem, nor are they restricted to certain regions or types of hospitals. Every minute in the United States, an ambulance is diverted. In 2004, almost half of all hospitals and nearly 70 percent of urban hospitals reported at least some time on diversions. Diversions affect both people being rushed to the nearest hospital at the onset of a medical crisis, as well as those being transferred from one hospital to a larger or more specialized one that can deliver life-saving care.

Ample evidence shows diversions hurt.

A study from New York City boroughs found the death rate from heart attacks increased by 47 percent on days when hospitals were on diversion. Patient care suffers, too, when more than one hospital in a given area is on diversion.

Another comprehensive study found that when more than 60 percent of area hospitals are on diversion, median treatment time for heart attacks increased by almost 10 minutes.

And research in Houston found that the death rate for severely injured patients requiring inter-hospital transfer was about 10 percent higher on "high-diversion" days—25 percent on the high days, versus about 14 percent on low diversion days.

Tomorrow we'll look at the causes of diversion, and Monday we'll talk about what we can do about it.