In reply:

Abstract

We appreciate Mr. Barishansky's and Ms. O'Connor's interest in our article. The action taken by the City of Memphis that they describe, completely banning the practice of ambulance diversion, is an interesting one.1.Memphis adopts no-ambulance-diversion policy.EMS Insider. 2003; 30: 1-2Google Scholar Ambulance diversion may have become an avenue for emergency departments (EDs) to use to gain a temporary reprieve from additional patients arriving by emergency medical services (EMS) when conditions in that ED are such that the ability to care for additional patients is limited. However, the ability to request ambulance diversion may have become a “luxury” that is subject to abuse. Who determines the need for diversion, and on what basis, varies from hospital to hospital.Some institutions, in a concerted effort to minimize ambulance diversion, have put into place a system whereby a request for diversion is initiated by ED staff (usually the charge nurse, in conjunction with the attending emergency physician). This request is relayed to a member of hospital administration, who makes efforts to augment staffing on the wards or expedite discharges. These efforts can often culminate in getting admitted patients being held in the ED up to the wards, thereby reducing the crowding conditions in the ED and obviating the need to go on diversion in the first place.2.Schneider S. Zwemer F. Doniger A. et al.Rochester, New York: a decade of emergency department overcrowding.Acad Emerg Med. 2001; 8: 1044-1050Crossref PubMed Scopus (110) Google ScholarAs Barishansky and O'Connor point out, tackling the issue of ED crowding and its effect on our EMS system can only be seriously addressed on a broad scale. Successful efforts, such as those described in Memphis, as well as by individual hospitals, need to be quantified to formulate a “best practices” model for positive change. We appreciate Mr. Barishansky's and Ms. O'Connor's interest in our article. The action taken by the City of Memphis that they describe, completely banning the practice of ambulance diversion, is an interesting one.1.Memphis adopts no-ambulance-diversion policy.EMS Insider. 2003; 30: 1-2Google Scholar Ambulance diversion may have become an avenue for emergency departments (EDs) to use to gain a temporary reprieve from additional patients arriving by emergency medical services (EMS) when conditions in that ED are such that the ability to care for additional patients is limited. However, the ability to request ambulance diversion may have become a “luxury” that is subject to abuse. Who determines the need for diversion, and on what basis, varies from hospital to hospital. Some institutions, in a concerted effort to minimize ambulance diversion, have put into place a system whereby a request for diversion is initiated by ED staff (usually the charge nurse, in conjunction with the attending emergency physician). This request is relayed to a member of hospital administration, who makes efforts to augment staffing on the wards or expedite discharges. These efforts can often culminate in getting admitted patients being held in the ED up to the wards, thereby reducing the crowding conditions in the ED and obviating the need to go on diversion in the first place.2.Schneider S. Zwemer F. Doniger A. et al.Rochester, New York: a decade of emergency department overcrowding.Acad Emerg Med. 2001; 8: 1044-1050Crossref PubMed Scopus (110) Google Scholar As Barishansky and O'Connor point out, tackling the issue of ED crowding and its effect on our EMS system can only be seriously addressed on a broad scale. Successful efforts, such as those described in Memphis, as well as by individual hospitals, need to be quantified to formulate a “best practices” model for positive change.