NCPA - National Center for Policy Analysis


June 3, 2009

Hospitals in the District and Maryland must frequently divert ambulances carrying all but the most critically ill and injured patients because of emergency room (ER) overcrowding, forcing many less-critical patients to travel farther for care, increasing costs and potentially causing dangerous delays, says the Washington Post.

Health-care analysts say ambulance diversions in the Washington region illustrate a national problem that has led some states to ban the practice.  But detailing the extent of concern is difficult because of the limited information available in many states, including Virginia, about how often those redirections occur and a lack of national standards, says the Post:

  • Since 2004, some District and Maryland hospitals have had to divert ambulance traffic with increasing frequency because they lacked the beds, equipment or staff for patients.
  • Some D.C. hospitals diverted ambulances the equivalent of one out of five days in 2008, and some Maryland hospitals' emergency rooms diverted ambulances at least 15 percent of the time last year, according to a Washington Post analysis of data from District and Maryland health authorities.

"That delay could be a matter of life and death," said Bruce Siegel, research professor in the Department of Health Policy at the George Washington University School of Public Health and Health Services.  "We should be very worried there are no national rules."

At the very least, the practice increases the cost of health care, says the Post.  When ambulances are diverted from crowded emergency rooms to less crowded ones farther away, the patients' records are often not available, leading to duplicate tests and procedures.  And patients' regular doctors might not be able to treat them at hospitals where they usually practice.

The reasons for the crowding often vary by hospital, says the Post:

  • Some, especially in the District, are overwhelmed by poor patients for whom the ER has become their family doctor's office.
  • Some suburban hospitals have not kept pace with population growth.
  • And in many instances, internal management problems are to blame, such as when hospitals don't move patients out of emergency rooms and discharge them or admit them for care elsewhere in the facility fast enough to prevent a backlog.

Different jurisdictions use different criteria about when to limit ambulance traffic.  Maryland has two categories -- yellow alerts for when emergency rooms are too crowded to accommodate additional patients and red alerts for when emergency rooms lack beds for patients who require monitoring, such as those with cardiac problems.

Source: Lori Aratani, "District, Md. Hospitals Often Divert Ambulances; Some ERs Too Crowded To Take More Patients," Washington Post, May 31, 2009.

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