A Cure for ER Diversions

Emergency Room diversions continue to be an issue in the news. The Washington Post, the beltway paper, recently reported on the problems associated with ER diversions in the District of Columbia and Maryland.

Diversions are when ambulances are sent to another ER because the nearest ER is too busy and does not believe they can safely provide care.

Since everyone else reported on the potential for adverse effects caused by extra travel, I thought it might be useful to understand that the hospital goes on diversion because it has determined that patient safety might be at risk if more critical patients were added to those already at the hospital.

Adding more work beyond the capacity of the ER not only jeopardizes the new patient but puts all the other patients at risk. For example, when an ER nurse has too many ER patients, there isn’t enough time to check on their status, comfort or educate them (or their families).

You might say, “Hire more nurses.” But, there may not be enough nurses available. And financially, where will the money come from when Medicare and Medicaid pay so poorly (not to mention the many uninsured patients)?

But there is another aspect of the problem that is controllable. Many hospitals do not adequately manage hospital length of stay. Many patients can be discharged or moved to another, less expensive, care provider safely and earlier. Critical care and telemetry beds are often filled with patients who don’t need those specialized services.

One hospital scrapped plans to build additional ICU beds after implementing a more effective case management/throughput management program. By managing bed utilization better, beds are made available for quicker transfer from the ER.

Other changes that would also speed ER patient care are to do more testing on patients who might need to be admitted in observation beds (non-ER) or in inpatient units instead of waiting for all the tests to be done before the patient is admitted. To make this happen, other things need to be done – but these also are within the hospital’s control.

Similarly, many times tests done in Emergency Rooms can be done for patients as outpatients. It’s a matter of coordination of care and reallocating resources.

The fact is that things can be done to admit patients to an inpatient bed faster or discharge patients from the ER faster. When these things are done the ERs can see more patients (and provide safer care), thereby reducing the need for ER diversions.

The solution is not “either/or” but “and.” We need social policies that reduce the influx of patients to the ER and we need management practices that do the best with what we have. Health care providers must do what they can, even if it’s not the total solution.

Filed Under: Featured Articles • Hospital Leadership

Tags: Emergency Room diversions, Featured Articles, patient throughput