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What is ED Diversion?

When a hospital and it's ED are overloaded to the point where they do not feel they can safely accept another patient, the hospital will typically go on "diversion" status which is to say that they generally will not accept new ambulance arrivals until they can recover to a perceived safer time period. The ability and the method of a hospital going on diversion varies widely by region and individual hospital protocols. There is also a lot of variation on who may authorize the hospital to go on diversion and how long they may be on divert status. Some hospitals go on diversion for only an hour; some go on diversion for several hours or even days. The most significant impact to our healthcare system is that the patient may be delayed in receiving hospital emergency care until the ambulance provider can find an open hospital. Another negative impact is that when one hospital goes on divert, it typically creates a surge at the near by hospital or hospitals, often creating a domino effect where those hospitals will become saturated and they go on diversion as well.

EDs and hospitals get overloaded (or saturated) for many reasons, including: boarding (holding patients that need an inpatient bed), staffing, CT scanner is down, the lack of ICU beds, internal disasters, and for many other reasons. However, there is a developing body of evidence that overcrowding is caused by a system of bottlenecks and inefficient processes within the hospital overall. A common perception for "curing" diversion is to add more ED or hospital beds. Most studies and research show that adding ED beds or hospital beds or expanding an ED without looking at the hospital's bottlenecks only temporarily solves the problem and that eventually the hospital will become saturated again.

In many hospitals, what needs to be addressed is the process a patient is taken through when they present to an ED and when a patient is admitted to the hospital. The California ED Diversion Project's goal is to help reduce or eliminate diversion for a few communities in California and publish those results so others can do the same.



Supported by the California HealthCare Foundation, based in Oakland, California.
© Copyright 2009 CA ED Diversion.

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