Community Trial to Decrease Ambulance Diversion Hours: The San Diego County Patient Destination Trial

2.50
Hdl Handle:
http://hdl.handle.net/10755/163055
Type:
Presentation
Title:
Community Trial to Decrease Ambulance Diversion Hours: The San Diego County Patient Destination Trial
Abstract:
Community Trial to Decrease Ambulance Diversion Hours: The San Diego County Patient Destination Trial
Conference Sponsor:Emergency Nurses Association
Conference Year:2004
Author:Metz, Marcelyn, RN, BS, CEN
P.I. Institution Name:County of San Diego, Division of EMS
Title:Quality Assurance Specialist
Contact Address:6255 Mission Gorge Road, San Diego, CA, 92120, USA
Contact Telephone:(619) 285-6429
Purpose: Emergency department ambulance diversion is a major issue in many communities. Ambulance
diversion reached a critical level in San Diego County in 2002, with 21 emergency departments on bypass
an average of 4000 hours per month. One identified cause of overcrowding was that of patients waiting
for interfacility transfers to their requested facility. When patients do not get to requested facilities, challenges
in care are compounded by lack of available medical records and delays in transferring admitted
patients back to the originally requested facility. This study evaluated a community intervention to reduce
ambulance diversion.
Design/Setting: A prospective, community intervention study with pre-, concurrent-, and post-intervention
measures was conducted. This study included all 21 hospitals in San Diego County with basic emergency
services. San Diego County has a resident population of approximately 3 million covering 4,300
square miles.
Sample: The sample consisted of prehospital patient records from all patients transported to emergency
departments by advanced life support (ALS) ambulance after accessing paramedics via 9-1-1 between
October 1, 2001 and September 30, 2003.
Methodology: Through community consensus, ambulance diversion guidelines were revised for all ambulance
agencies and emergency departments by the Emergency Medical Services Oversight Committee of
the San Diego County Medical Society. This revision recommended all emergency departments limit diversion
to one hour per instance and all paramedics to transport patients to their requested facility, condition
permitting. Participation by emergency departments was voluntary. The outcome measures included ambulance
transports, ambulance diversions, and bypass hours compared at pre-trial (10/01/01 - 9/30/02), trial
(10/01/02 - 12/31/02), and post-trial (01/01/03 - 09/30/03) periods.
Results: A total of 235,766 patients were transported to emergency departments by ALS ambulance during
the study. The total number of ambulance runs per month increased slightly from the pre-trail (n =
9,623) to the trial period (n = 9,818; p > 0.10), and significantly from the pre-trial to post-trial period (n =
10,093; p < 0.05). There were significant decreases (p < 0.001) in the average monthly hours on diversion
for both the trial period (1,079 hours) and post-trial period (1,774 hours) compared to the pre-trial period
(4,007 hours). There were significant decreases (p < 0.001) in the number of patients who did not get to
the requested facility because of diversion for both the trial (322 patients) and post-trial (449 patients)
periods compared to the pre-trial period (1320 patients).
Conclusion: Overcrowding of emergency departments triggered a national crisis in ambulance diversion.
The increase in ambulance runs made implementation of this intervention more challenging. The voluntary
community-wide approach to reducing ambulance diversion hours by transporting patients directly to
requested facilities was significantly effective. [Poster Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleCommunity Trial to Decrease Ambulance Diversion Hours: The San Diego County Patient Destination Trialen_GB
dc.identifier.urihttp://hdl.handle.net/10755/163055-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Community Trial to Decrease Ambulance Diversion Hours: The San Diego County Patient Destination Trial</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Metz, Marcelyn, RN, BS, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">County of San Diego, Division of EMS</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Quality Assurance Specialist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">6255 Mission Gorge Road, San Diego, CA, 92120, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(619) 285-6429</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">marcy.metz@sdcounty.ca.gov</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Emergency department ambulance diversion is a major issue in many communities. Ambulance<br/>diversion reached a critical level in San Diego County in 2002, with 21 emergency departments on bypass<br/>an average of 4000 hours per month. One identified cause of overcrowding was that of patients waiting<br/>for interfacility transfers to their requested facility. When patients do not get to requested facilities, challenges<br/>in care are compounded by lack of available medical records and delays in transferring admitted<br/>patients back to the originally requested facility. This study evaluated a community intervention to reduce<br/>ambulance diversion.<br/>Design/Setting: A prospective, community intervention study with pre-, concurrent-, and post-intervention<br/>measures was conducted. This study included all 21 hospitals in San Diego County with basic emergency<br/>services. San Diego County has a resident population of approximately 3 million covering 4,300<br/>square miles.<br/>Sample: The sample consisted of prehospital patient records from all patients transported to emergency<br/>departments by advanced life support (ALS) ambulance after accessing paramedics via 9-1-1 between<br/>October 1, 2001 and September 30, 2003.<br/>Methodology: Through community consensus, ambulance diversion guidelines were revised for all ambulance<br/>agencies and emergency departments by the Emergency Medical Services Oversight Committee of<br/>the San Diego County Medical Society. This revision recommended all emergency departments limit diversion<br/>to one hour per instance and all paramedics to transport patients to their requested facility, condition<br/>permitting. Participation by emergency departments was voluntary. The outcome measures included ambulance<br/>transports, ambulance diversions, and bypass hours compared at pre-trial (10/01/01 - 9/30/02), trial<br/>(10/01/02 - 12/31/02), and post-trial (01/01/03 - 09/30/03) periods.<br/>Results: A total of 235,766 patients were transported to emergency departments by ALS ambulance during<br/>the study. The total number of ambulance runs per month increased slightly from the pre-trail (n =<br/>9,623) to the trial period (n = 9,818; p &gt; 0.10), and significantly from the pre-trial to post-trial period (n =<br/>10,093; p &lt; 0.05). There were significant decreases (p &lt; 0.001) in the average monthly hours on diversion<br/>for both the trial period (1,079 hours) and post-trial period (1,774 hours) compared to the pre-trial period<br/>(4,007 hours). There were significant decreases (p &lt; 0.001) in the number of patients who did not get to<br/>the requested facility because of diversion for both the trial (322 patients) and post-trial (449 patients)<br/>periods compared to the pre-trial period (1320 patients).<br/>Conclusion: Overcrowding of emergency departments triggered a national crisis in ambulance diversion.<br/>The increase in ambulance runs made implementation of this intervention more challenging. The voluntary<br/>community-wide approach to reducing ambulance diversion hours by transporting patients directly to<br/>requested facilities was significantly effective. [Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:38:48Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:38:48Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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