When an ambulance is diverted from the nearest emergency room to another one further away, heart attack patients have a greater chance of dying both on the occasion of the attack and up to a year afterward, according to a new study.
Out of 13,860 Medicare patients, researchers found that a modest but significant proportion had a greater chance of dying when their nearest emergency department had a high rate of ambulance diversion. These higher death rates remained true for patients 30 days, 90 days, and 9 months after the initial episode.
In addition to the higher mortality rates, differences in treatment patterns emerged, with lower rates of catheterization and other emergency procedures employed in hospitals that divert ambulances more often.
The results came as no surprise to many in the medical community. Dr. Carl Ramsay, chairman of the department of emergency medicine at Lenox Hill Hospital in New York City, said, "While the public sees ambulance diversion as a sign of ED overcrowding, those of us in emergency medicine have known for years that it actually reflects failed processes in the [non-emergency department] areas of the hospital." Ramsay was not involved in the study.
"How many people actually know that unbalanced surgical scheduling by stacking up Monday through Thursday {operating room] schedules creates ED overcrowding, which creates ambulance diversion?" he added.
The authors of the study, Yu-Chu Shen of the National Bureau of Economic Research, Cambridge, Massachussets, and Dr. Renee Y. Hsia, of the University of California, San Francisco, said that their results pointed to a need for “more targeted interventions to appropriately distribute system-level resources in such a way to decrease crowding and diversion.”
