Abstract
Introduction:Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion.Methods:Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields.Results:We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion.Conclusion:Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals are promising avenues for reducing diversion.
Highlights
Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear
While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion
Baseline scenario: No cooperative agreement between neighboring emergency departments (ED) Alternative scenarios tested through optimal combination of the two policies: Ambulance diversion polices: 1) Ban diversion; 2) Simple ambulance diversion: ambulance diversion when all beds in the ED are occupied; 3) optimized single factor ambulance diversion: threshold triggered for a particular state that offers best balance between wait times and time on diversion
Summary
Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion. It has been linked to several negative consequences, such as prolonged transport times, delays in care, increased mortality, and lower hospital revenue.[4,5,6,7,8,9,10,11,12] In response, several efforts have been enacted to reduce ambulation diversion.[12,13,14] For hospitals, strategies to reduce diversion include implementing ED and hospital patient-flow Ambulance diversion has been used since the early 1990s.2,3 It has been linked to several negative consequences, such as prolonged transport times, delays in care, increased mortality, and lower hospital revenue.[4,5,6,7,8,9,10,11,12] In response, several efforts have been enacted to reduce ambulation diversion.[12,13,14] For hospitals, strategies to reduce diversion include implementing ED and hospital patient-flow
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
