Ambulance diversion reduction: The sacramento solution

Abstract

Study objectives: The diversion of ambulances away from their intended emergency departments (EDs) in the United States has become commonplace and may compromise patient care. Although ambulance diversion resulting from ED crowding has been well described in the literature, little is known about how to reduce the incidence of ambulance diversion on a regional level. We describe the development, implementation, and impact of a region-wide program to reduce ambulance diversion. Methods: This study was undertaken in the greater Sacramento, CA, region from January 2001 to December 2003. This comprehensive ambulance diversion reduction program was implemented May 15, 2002, with analysis of data for this 3-year timeframe. The data for this study were obtained from 17 hospitals under the oversight of the Hospital Council of Northern and Central California and a nonaffiliated consulting group. The main outcome measure for this study is the number of combined hours of ambulance diversion for 17 hospitals throughout the region. Results: The greater Sacramento region had 23,785 hours of ambulance diversion in 2001 before the implementation of this program. In 2002, the year of program implementation, ambulance diversion was decreased to 11,563 hours, a 51.4% reduction (95% confidence interval [CI] 50.8 to 52.0; P P =.076). The overall reduction in ambulance diversion in 2003 compared with the 2001 preimplementation hours was 70% (95% CI 69.4 to 70.6; P Conclusion: Our results demonstrate a sizeable reduction of ambulance diversion in a large urban region after the successful implementation of a comprehensive ambulance diversion reduction program. Notably, this reduction occurred despite overall increases in ED census, hospital admissions, ambulance transports, and overall Sacramento population. This program may serve as a model of ambulance diversion reduction for other regions across the country.