Emergency Department Overcrowding and Ambulance Diversion

1
Emergency Department Overcrowding and Ambulance
Diversion

• Mary L. Kopp, BSN, RN
• Nurse Manager for Emergency Services
• Scottsdale Healthcare Shea

2
Development of a Community Plan

• Historical-- the need to understand diversion
• Community Concern
• Diversion had a negative connotation
• Understanding that diversion was not just a
  hospital problem
• Arizona Emergency Medical Services (AEMS)
  Assigned a Diversion Task Force
• Provide timely transport of patients
• Deliver quality care to our community
• Determine when hospitals reached saturation

3
Develop Diversion Guidelines

• State the purpose
• Determines Standard of Care
• Identify the goal
• Consistent definitions of terminology
• Establish categories
• ED/Trauma Saturation
• Facility Internal Disaster
• Determine facility/pre-hospital responsibilities
• Authorizing/Monitoring of diversion
• Prompted national search for computerized
  technology

4
Computerized Technology

• Automated Internet System
• Partnership between Arizona Healthcare Hospital
  Association and Phoenix Fire
• Program needed to include
• Assignment of diversion
• How many hospitals are on diversion
• Clarifying operational issues
• Tracking of diversion hours by facility
• Integration of the EMSystem
• Real time diversion status
• Cancellation of Pre-hospital Diversion
• Community need to access emergency care
• System overload- sector 2/3 capacity

5
Automatic Cancellation of Diversion

• Quantifiable Data
• Determine a saturation percentage
• Determine whom dispatch would place on automatic
  cancellation of diversion
• Development of the AEMS Facility Diversion
  Worksheet
• List factors of why emergency departments go on
  diversion
• Assign number to quantify factors

6
Which Hospital Comes Up On Diversion?

• Geographic sector assignments for Central Arizona
• Understanding guidelines of 2/3 system overload
• calculated by each hospital
• Which facility stays on diversion, for how long
• Rotation of all facilities until all facilities
  have returned to normal
• Need for individual hospital strategies for
  saturation

7
Future On-line Capability

• Continue to Develop Quality Reports
• Research Support
• State Wide Implementation
• Bioterrorism Surveillance