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:: Volume 13, Issue 3 (10-2024) ::
Int J Med Invest 2024, 13(3): 1-23 Back to browse issues page
Strategies For The Management Of Ambulance Diversion And Emergency Department Overcrowding: A Systematic Review
Masoud Shahabian , Mehdi Arzani Shamsabadi , Seyed Zia Hejripour * , Ali Omrani Nava , Mahdi Foroughian , Maryam Mohammadi
Assistant Professor of Emergency Medicine, Surgery and Trauma Research Center, AJA University of Medical Sciences, Tehran, Iran
Abstract:   (172 Views)
The issue of overcrowding in emergency departments stands out as a critical concern in overpopulated cities. Access block is defined as situations when patients in the emergency department (ED) have no access to appropriate hospital beds within reasonable time despite their needs for inpatient care, leading to overcrowding and ambulance diversion (AD). AD is regarded as a controversial strategy to alleviate ED congestion, curbing the input visits and is executed as a measure when EDs request ambulances to transport the patients to less crowded hospitals. This systematic review gathered the main strategies which are applied in the real world to decrease AD and ED overcrowding. An exploration of PubMed, Medline, and Web of Science databases was undertaken to scrutinize articles from November 1-25, 2020. Eventually, we found 18 pre and post-intervention studies which developed strategies in real situations to decrease AD in an attempt to reduce ED overcrowding. The findings pointed to the enhancement of agency capacity whether by increasing the number of beds in the emergency room or developing an acute care unit  (ACU) as a new form of controlling patient flow at the back end of the  ED using the AD ban and no-diversion policy, formation of improvement teams, collaboration of hospitals and emergency medical services agencies, and determination of optimal patient destination by a destination-control physician as the main strategies to reduce AD in order to increase ED overcrowding.
 
Keywords: Medical services agencies, Emergency department, Overcrowding, Ambulance diversion.
Full-Text [PDF 888 kb]   (61 Downloads)    
Type of Study: Review | Subject: General
References
1. 1. Institute of Medicine Committee on the Future of Emergency Care in the U.S. Health System. The future of emergency care in the United States health system. Ann Emerg Med. 2006 Aug;48(2):115-20. 2. Yarmohammadian MH, Rezaei F, Haghshenas A, Tavakoli N. Overcrowding in emergency departments: a review of strategies to decrease future challenges. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2017;22. 3. Bullard MJ, Villa-Roel C, Guo X, Holroyd BR, Innes G, Schull MJ, et al. The role of a rapid assessment zone/pod on reducing overcrowding in emergency departments: a systematic review. Emergency Medicine Journal. 2012;29(5):372-8. 4. Lindner G, Woitok BK. Emergency department overcrowding. Wiener klinische Wochenschrift. 2020:1-5. 5. Derlet RW, Richards JR, Kravitz RL. Frequent overcrowding in US emergency departments. Academic Emergency Medicine. 2001;8(2):151-5. 6. Olshaker JS, Rathlev NK. Emergency department overcrowding and ambulance diversion: the impact and potential solutions of extended boarding of admitted patients in the emergency department. The Journal of emergency medicine. 2006;30(3):351-6. 7. Lee YJ, Do Shin S, Lee EJ, Cho JS, Cha WC. Emergency department overcrowding and ambulance turnaround time. PloS one. 2015;10(6):e0130758. 8. Espi-sa G, Miro O, Sánchez M, Coll-Vinent B, Millá J. Effects of external and internal factors on emergency department overcrowding. Annals of emergency medicine. 2002;39(6):693. 9. Milam EC, Nassau S, Banta E, Fonacier L, Cohen DE. Occupational contact dermatitis: an update. The Journal of Allergy and Clinical Immu-logy: In Practice. 2020;8(10):3283-93. 10. Anantharaman V. Impact of health care system interventions on emergency department utilization and overcrowding in Singapore. International Journal of Emergency Medicine. 2008;1(1):11-20. 11. Nash K, Nguyen H, Tillman M. Using medical screening examinations to reduce emergency department overcrowding. Journal of Emergency Nursing. 2009;35(2):109-13. 12. Siegel B. Triage for overcrowding. Modern healthcare. 2003;33(27):24-. 13. Burt CW, McCaig LF, Valverde RH. Analysis of ambulance transports and diversions among US emergency departments. Annals of emergency medicine. 2006;47(4):317-26. 14. Nawar E, Niska R, Xu J. National Hospital Ambulatory Medical Care Survey—2005 emergency department survey: advance data for vital health statistics, number 386, June 29, 2007. CDC Web site. CDC Web site)(Accessed August 11, 2007) http://www cdc gov/nchs/data/ad/ad386 pdf View in Article. 2007. 15. Scheulen JJ, Li G, Kelen GD. Impact of ambulance diversion policies in urban, suburban, and rural areas of Central Maryland. Academic Emergency Medicine. 2001;8(1):36-40. 16. Nafarrate AR, Fowler JW, Wu T, editors. Bi-criteria analysis of ambulance diversion policies. Proceedings of the 2010 Winter Simulation Conference; 2010: IEEE. 17. Green S, Higgins J. Cochrane handbook for systematic reviews of interventions. Version; 2005. 18. Higgins J. Cochrane handbook for systematic reviews of interventions. Version 5.1. 0 [updated March 2011]. The Cochrane Collaboration. www cochrane-handbook org. 2011. 19. McConnell KJ, Richards CF, Daya M, Bernell SL, Weathers CC, Lowe RA. Effect of increased ICU capacity on emergency department length of stay and ambulance diversion. Annals of emergency medicine. 2005;45(5):471-8. 20. McLeod B, Zaver F, Avery C, Martin DP, Wang D, Jessen K, et al. Matching capacity to demand: a regional dashboard reduces ambulance avoidance and improves accessibility of receiving hospitals. Academic Emergency Medicine. 2010;17(12):1383-9. 21. Yancer DA, Foshee D, Cole H, Beauchamp R, de la Pena W, Keefe T, et al. Managing capacity to reduce emergency department overcrowding and ambulance diversions. The Joint Commission Journal on Quality and Patient Safety. 2006;32(5):239-45. 22. Burke LG, Joyce N, Baker WE, Biddinger PD, Dyer KS, Friedman FD, et al. The effect of an ambulance diversion ban on emergency department length of stay and ambulance turnaround time. Annals of emergency medicine. 2013;61(3):303-11. e1. 23. Watase T, Fu R, Foster D, Langley D, Handel DA. The impact of an ED-only full-capacity protocol. The American journal of emergency medicine. 2012;30(8):1329-35. 24. Lee I-H, Chen C-T, Lee Y-T, Hsu Y-S, Lu C-L, Huang H-H, et al. A new strategy for emergency department crowding: high-tur-ver utility bed intervention. Journal of the Chinese Medical Association. 2017;80(5):297-302. 25. Friedman FD, Rathlev NK, White L, Epstein SK, Sayah A, Pearlmutter M, et al. Trial to end ambulance diversion in Boston: report from the conference of the Boston teaching hospitals consortium. Prehospital and Disaster Medicine. 2011;26(2):122. 26. Kelen GD, Scheulen JJ, Hill PM. Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services diversion. Academic Emergency Medicine. 2001;8(11):1095-100. 27. Patel PB, Vinson DR. Ambulance diversion reduction and elimination: the 3-2-1 plan. The Journal of Emergency Medicine. 2012;43(5):e363-e71. 28. Patel PB, Derlet RW, Vinson DR, Williams M, Wills J. Ambulance diversion reduction: the Sacramento solution. The American journal of emergency medicine. 2006;24(2):206-13. 29. Vilke GM, Castillo EM, Metz MA, Ray LU, Murrin PA, Lev R, et al. Community trial to decrease ambulance diversion hours: the San Diego county patient destination trial. Annals of Emergency Medicine. 2004;44(4):295-303. 30. Asamoah OK, Weiss SJ, Ernst AA, Richards M, Sklar DP. A -vel diversion protocol dramatically reduces diversion hours. The American journal of emergency medicine. 2008;26(6):670-5. 31. Rogers KS. Evidence Based Change: A Protocol to Reduce Ambulance Diversion Using the National Emergency Department Overcrowding Scale Tool. 32. Howell E, Bessman E, Kravet S, Kolodner K, Marshall R, Wright S. Active bed management by hospitalists and emergency department throughput. Annals of internal medicine. 2008;149(11):804-10. 33. Willard E, Carlton EF, Moffat L, Barth BE. A full-capacity protocol allows for increased emergency patient volume and hospital admissions. Journal of Emergency Nursing. 2017;43(5):413-8. 34. Castillo EM, Vilke GM, Williams M, Turner P, Boyle J, Chan TC. Collaborative to Decrease Ambulance Diversion: The California Emergency Department Diversion Project. The Journal of Emergency Medicine. 2011;40(3):300-7. 35. Vilke GM, Brown L, Skogland P, Simmons C, Guss DA. Approach to decreasing emergency department ambulance diversion hours. The Journal of emergency medicine. 2004;26(2):189-92. 36. Shah MN, Fairbanks RJ, Maddow CL, Lerner EB, Syrett JI, Davis EA, et al. Description and Evaluation of a Pilot Physician‐directed Emergency Medical Services Diversion Control Program. Academic emergency medicine. 2006;13(1):54-60. 37. Huang J-A, Tsai W-C, Chen Y-C, Hu W-H, Yang D-Y. Factors associated with frequent use of emergency services in a medical center. Journal-Formosan Medical Association. 2003;102(4):222-8. 38. Muscatello DJ, Bein KJ, Dinh MM. Emergency Department demand associated with seasonal influenza, 2010 through 2014, New South Wales, Australia. Western Pacific surveillance and response journal: WPSAR. 2017;8(3):11. 39. Lambe S, Washington DL, Fink A, Laouri M, Liu H, Fosse JS, et al. Waiting times in California's emergency departments. Annals of emergency medicine. 2003;41(1):35-44. 40. Cooke M, Wilson S, Halsall J, Roalfe A. Total time in English accident and emergency departments is related to bed occupancy. Emergency Medicine Journal. 2004;21(5):575-6. 41. Bernstein SL, Verghese V, Leung W, Lunney AT, Perez I. Development and validation of a new index to measure emergency department crowding. Academic Emergency Medicine. 2003;10(9):938-42. 42. Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo Jr CA. A conceptual model of emergency department crowding. Annals of emergency medicine. 2003;42(2):173-80. 43. Schull MJ, Vermeulen M, Slaughter G, Morrison L, Daly P. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Annals of emergency medicine. 2004;44(6):577-85. 44. Rathlev N, Chessare J, Olshaker J, Obendorfer D. The probability of emergency department diversion status as a function of inpatient occupancy. Annals of Emergency Medicine. 2004;44(4):S29. 45. Schneider S, Zwemer F, Doniger A, Dick R, Czapranski T, Davis E. Rochester, New York a decade of emergency department overcrowding. Academic Emergency Medicine. 2001;8(11):1044-50. 46. McConnell K, Richards C, Daya M, Lowe R. Effect of increased icu capacity on length of stay in the emergency department. Annals of Emergency Medicine. 2004;44(4):S8. 47. McManus M, editor Emergency department overcrowding in Massachusetts: making room in our hospitals. Issue brief (Massachusetts Health Policy Forum); 2001. 48. Litvak E, McManus ML, Cooper A. Root cause analysis of emergency department crowding and ambulance diversion in Massachusetts. Boston University Program for Management Variablity in Health Care Delivery. 2002;4(6):4.5. 49. Reform EC. Executive Briefing for Clinical Leaders. 1998. The Watergate, Washington DC: Advisory Board Company. 50. Brewster LR, Felland LE. Emergency department diversions: hospital and community strategies alleviate the crisis. Issue Brief (Center for Studying Health System Change). 2004(78):1-4. 51. Shactman D, Altman SH, Eilat E, Thorpe KE, Doonan M. The outlook for hospital spending. Health Affairs. 2003;22(6):12-26. 52. Bazzoli GJ, Brewster LR, Liu G, Kuo S. Does US hospital capacity need to be expanded? Health Affairs. 2003;22(6):40-54. 53. O'Reilly K. Halting ambulance diversions didn't affect ED waits. American Medical News. 2010. 54. Castillo EM, Chan TC. California ED Diversion Project Evaluation. 2009. 55. Kowalczyk L. State orders ERs to halt “diversions”: bid to ease overcrowding seen to sometimes delay care. Boston Globe. 2008(September 13). 56. Forster AJ, Stiell I, Wells G, Lee AJ, Van Walraven C. The effect of hospital occupancy on emergency department length of stay and patient disposition. Academic Emergency Medicine. 2003;10(2):127-33. 57. Rathlev NK, Chessare J, Olshaker J, Obendorfer D, Mehta SD, Rothenhaus T, et al. Time series analysis of variables associated with daily mean emergency department length of stay. Annals of emergency medicine. 2007;49(3):265-71. 58. Schull MJ, Lazier K, Vermeulen M, Mawhinney S, Morrison LJ. Emergency department contributors to ambulance diversion: a quantitative analysis. Annals of emergency medicine. 2003;41(4):467-76. 59. Quinn JV, Mahadevan SV, Eggers G, Ouyang H, -rris R. Effects of implementing a rapid admission policy in the ED. The American journal of emergency medicine. 2007;25(5):559-63. 60. Hoot NR, LeBlanc LJ, Jones I, Levin SR, Zhou C, Gadd CS, et al. Forecasting emergency department crowding: a discrete event simulation. Annals of emergency medicine. 2008;52(2):116-25. 61. Hoot N, Aronsky D, editors. An early warning system for overcrowding in the emergency department. AMIA Annual Symposium Proceedings; 2006: American Medical Informatics Association. 62. Leegon J, Hoot N, Aronsky D, Storkey A, editors. Predicting ambulance diversion in an adult Emergency Department using a Gaussian process. AMIA annual symposium proceedings; 2007: American Medical Informatics Association. 63. Larson G. Ambulance destination determination system for ambulance distribution as an alternative to ambulance diversion. Journal of Emergency Nursing. 2008;34(4):357-8.
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Shahabian M, Shamsabadi M A, Hejripour S Z, Nava A O, Foroughian M, Mohammadi M. Strategies For The Management Of Ambulance Diversion And Emergency Department Overcrowding: A Systematic Review. Int J Med Invest 2024; 13 (3) :1-23
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Volume 13, Issue 3 (10-2024) Back to browse issues page
International Journal of Medical Investigation
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