Los Angeles County ER Overcrowding Forces Increased Ambulance Diversions
Ambulance diversions that were once limited to "busy inner city hospitals" or during the winter flu season are now "spread out all over the place," and emergency room overcrowding at Los Angeles County hospitals has become such an "everyday problem" that ambulances are "routinely" diverted to other facilities, the Los Angeles Times reports. Originally designed to allow busy emergency rooms 30 minutes to "catch up," diversions have "ballooned into eight- to 16-hour occurrences." For example, in Los Angeles County during the first three months of this year, 31% of the 10,519 emergency room diversion requests were for more than eight hours. In addition, Los Angeles County hospital emergency rooms were "on diversion" for 16,000 hours in March, compared with 11,000 hours during the same period last year. While there have been no studies on whether diversions have contributed to patient deaths, a report released last week by the Center for Studying Health System Change found that "serious threats to patient care are emerging." The Times reports that the emergency room back-up is caused in part by the "worsening" nursing shortage, fewer inpatient beds because of hospital closures and mergers, a declining number of specialists willing to be on call and an increasing number of uninsured residents using emergency rooms for primary care. In addition, the center's study found that managed care companies' decision to loosen emergency care restrictions has contributed to "double-digit increases" in emergency room use. Robert Splawn, medical director of emergency services at California Hospital Medical Center in Los Angeles, said the "burden" of treating patients falls on the 911 system and paramedics, which delay services to "others in need."
In Los Angeles County, hospitals are required to "reassess diversions" every eight hours. However, the commission that oversees the county's emergency services is expected on Wednesday to approve a proposal to shorten the reassessment time to every four hours. Hospitals have also agreed to make on-call specialists available to treat local emergency patients. However, Dr. Daniel Higgins, director of emergency services at Lynwood-based St. Francis Medical Center, said that the diversions are "a symptom of an unsolved crisis in emergency care." He added, "When everybody is diverting so much, something is wrong with the system. You've got multiple hospitals with several gurneys lining up trying to get care. There's a domino effect causing this" (Allen, Los Angeles Times, 5/14). The study findings are detailed in an issue brief available at http://www.hschange.org/CONTENT/312/.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.