Standardizing criteria across hospitals could help reduce the practice of ambulance diversion, as could reductions in emergency department boarding and increased coverage of uninsured patients, a new report suggests.
Currently, hospitals in most areas decide on their own when and how often to go on diversion, which leads to a chaotic system and poses health risks to patients who may be delayed in getting needed care, said Dr. Guy Clifton, professor of neurosurgery at the University of Texas, Houston.
Dr. Clifton coauthored the report, “Ambulance Diversions: What They Are, Why We Care, and What to Do,” for the New America Foundation, a Washington, D.C.-based public policy institute.
Covering uninsured patients also would help curb diversion, because it would reduce the number of nonurgent cases contributing to emergency department crowding, he said in an interview.
Before joining the foundation, Dr. Clifton was a Robert Wood Johnson Foundation Health Policy Fellow in the office of Sen. Orrin Hatch (R-Utah). He also wrote the forthcoming book “Flatlined: Resuscitating American Medicine” (Piscataway, N.J.: Rutgers University Press, 2009), which takes on the issues raised by the huge number of uninsured Americans.
According to the report, about half of hospitals and 70% of urban hospitals reported at least some time on diversion in 2004. The diversion picture is a bit fuzzy, he said.
Dr. Clifton said that because there is a shortage of primary care providers, many people, even those with insurance, are receiving less preventive care. When they come to the emergency department, they are not seeking nonurgent help, and are often sick enough that they require admission.
Diversion standards, data collection, and public reporting should be instituted nationally, he said.
For a copy of the report, visit www.newamerica.net/files/Ambulance%20Diversions.pdf