Ambulance Diversion Reduction and Elimination: The 3-2-1 Plan

Abstract

BackgroundThe diversion of ambulances from their intended emergency departments (EDs) occurs frequently, compromising patient care. Previously, we reduced ambulance diversion (AD) by 74% in a large urban area with 17 EDs. ObjectivesIn this follow-up program, we sought to further reduce and eliminate AD by progressively reducing the duration of each AD event. MethodsUsing tight diversion criteria, AD at each ED was limited by protocol to 3h at a stretch, after which incoming ambulances had to be accepted at that ED for at least 1h. After 6 months, AD was limited to 2h per diversion event; after another 6 months, AD was limited to 1h. The monitoring for AD was programmed into a region-wide, Internet-based Emergency Medical Services (EMS) program. ResultsTotal annual AD decreased from 8469h in 2006 (pre-implementation) to 4592h in 2007 (during implementation), and finally to 2439h and 2306h in 2008 and 2009 (post-implementation), respectively, an 87.4% (95% confidence interval 64.6–95.5%) reduction, and one county within the region eliminated AD altogether. From 2006 to 2009, overall increases were noted in EMS arrivals (7.8%), ED census (13.0%), hospital admissions (6.6%), Intensive Care Unit admissions (17.1%), and overall Sacramento population (1.9%). ConclusionsBy limiting the duration of AD events to progressively shorter periods of time using a region-wide, Internet-based EMS program, we reduced AD hours in 17 EDs by 87.4% and eliminated AD in one entire county. This original, collaborative 3-2-1 Plan may be readily reproduced across the country to progressively reduce and eliminate AD.