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Trial to End Ambulance Diversion in Boston: Report from the Conference of the Boston Teaching Hospitals Consortium

Published online by Cambridge University Press:  03 May 2011

Franklin D. Friedman ,
Niels K. Rathlev ,
Laura White ,
Stephen K. Epstein ,
Assaad Sayah ,
Mark Pearlmutter ,
Paul Biddinger ,
Richard Zane  and
Peter Moyer
Franklin D. Friedman
Affiliation:
Tufts Medical Center, Department of Emergency Medicine Boston, Massachusetts USA
Niels K. Rathlev*
Affiliation:
Boston Medical Center, Boston, Massachusetts USA Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts USA
Laura White
Affiliation:
Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts USA
Stephen K. Epstein
Affiliation:
Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts USA
Assaad Sayah
Affiliation:
Cambridge Health Alliance, Department of Emergency Medicine, Cambridge, Massachusetts USA
Mark Pearlmutter
Affiliation:
St. Elizabeth's Medical Center, Department of Emergency Medicine, Boston, Massachusetts USA
Paul Biddinger
Affiliation:
Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts USA
Richard Zane
Affiliation:
Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts USA
Peter Moyer
Affiliation:
Boston Emergency Medical Services, Police, and Fire, Boston, Massachusetts USA
*
Correspondence: Niels K. Rathlev, MD Department of Emergency Medicine Baystate Medical Center759 Chestnut St.Springfield, MA 01199 USA E-mail: Niels.Rathlev@tufts.edu
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Abstract

Introduction: Annual ambulance diversion hours in Boston increased more than six-fold from 1997 to 2006. Although interventions and best practices were implemented, there was no reduction in the number of diversion hours.

Objectives: A consortium of Boston teaching hospitals instituted a two-week moratorium on citywide diversion from 02 October 2006 to 15 October 2006. The hypothesis was that there would be no significant difference in measures of hospital and emergency medical services (EMS) efficiency compared with the two weeks immediately prior.

Methods: A total of nine hospitals and the municipal emergency medical services in Boston submitted data for analysis. The following mean daily hospital measures were studied: (1) emergency department volume; (2) number of emergency department admissions; (3) length of stay (LOS) for all patients; and (4) number of elopements. Mean EMS at-hospital time by destination and the percent of all Boston EMS transports to each hospital destination were calculated. The median differences (MD) were calculated as “before” minus “during” the study period and were compared with paired, Wilcoxon, non-parametric tests. Additional mean EMS measures for all destinations included: (1) to hospital time; (2) number of responses with transport initiated per day; (3) incident entry to arrival; and (4) at-hospital time.

Results: The LOS for admitted patients (MD = 0.30 hours; IQR 0.10,1.30; p = 0.03) and number of daily admissions (MD = -1.50 patients; IQR -1.50, -0.10; p = 0.04) were significantly different statistically. The results for LOS for all patients, LOS for discharged patients, ED volume, EMS time at hospital by destination, number of elopements, and percent of Boston EMS transports to each hospital revealed no statistically significant differences. The difference between the study and control periods for mean EMS to hospital time, at-hospital time, and incident entry to arrival was a maximum of 0.6 minutes. The vast majority of EMS respondents to an online survey believed that the “no diversion” policy should be made routine practice.

Conclusions: The LOS for admitted patients decreased by 18 minutes, and the number of admissions increased by 1.5 patients per day during the study period. The “no diversion” policy resulted in minimal changes in EMS efficiency and operations. Diversion was temporarily eliminated in a major city without significant detrimental changes in ED, hospital, or EMS efficiency.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 26 , Issue 2 , April 2011 , pp. 122 - 126
Copyright
Copyright Friedman © World Association for Disaster and Emergency Medicine 2011

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