Ambulances Diverted from Emergency Rooms
Ambulances in Boston, San Francisco, Phoenix and Denver are being turned away from emergency rooms, the New York Times reports. More than 80% emergency department directors surveyed this year said they had diverted ambulances from their ERs, and 38% reported seeing ER crowding lead to "adverse outcomes," according to a Massachusetts College of Emergency Physicians survey. Massachusetts General Hospital -- "considered one of the country's best hospitals" -- has been "on diversion" around 45 hours a week, and an average of two Boston ERs close to ambulances at some point each day. Observers attribute the problem to a shortage of beds in intensive and critical care units, which causes patients to get "stuck" in ERs, causing the system to "descen[d] into gridlock."
Exacerbating the problem are uninsured patients being admitted to emergency rooms; managed care's "fail[ure]" to "keep patients out of the emergency room"; a shortage of nurses; and an "aging population" that is "older and sicker than in the past." The harm caused by ambulance diversions is difficult to quantify, the Times reports, but doctors said that "patient harm" "unquestionably existed." Physicians and ER workers "worry openly" that extra time spent in ambulances will compromise patient health, and are concerned that the problem will worsen when flu season hits and demand for ambulances increases. The Times reports that January's Annals of Emergency Medicine warns that "unless the problem [of ambulance diversions] is solved, the general public may no longer be able to rely on emergency departments for quality and timely emergency care, placing the people of this country at risk" (Goldberg, New York Times, 12/17)."