Collaborative to Decrease Ambulance Diversion: The California Emergency Department Diversion Project

Background: Ambulance diversion is a national problem that affects more than half of all emergency departments (EDs). Although diversion was meant to be used for short periods of time to offer temporary relief to EDs, it has evolved into a normal routine in many communities to manage the growing problem of ED and hospital crowding. Study Objectives: To assess the impact of a collaborative effort to decrease ambulance diversion. Methods: This is a pre/post study investigating ED diversion in four emergency medical services agency regions in California from September 2006 through August 2008. Hospitals developed and implemented a number of best practices revolved around patient flow initiatives, specifically looking to improve input, throughput, and output. Monthly ED diversion data are compared and reported as means and standard deviations (SD). Results: During the study period, there were a total of 31,735 diversion hours in the collaborative regions, with 17,618 during the pre-consortium period and 14,117 in the post-consortium period (19.9% decrease). The monthly average hours of diversion before the consortium was 1468 (SD = 390.6). This decreased to 1176 (SD = 605.8) after the initiation of the consortium (difference of 292 h; 95% confidence interval 99–484; p = 0.007). There was a decrease in diversion hours for every month-to-month comparison except January and February (increases of 1% and 14.6%, respectively). Conclusion: This study suggests that a decrease in ambulance diversion can be achieved through ongoing collaboration and the implementation of best practices. Continued communication and emphasis on diversion are likely needed to sustain these decreases.