Milwaukee County hospitals can no longer divert ambulances, per a new policy that took effect this month, and organizations have responded in various ways, according to a Journal Sentinel report.
The new policy has been in the works for several years and is meant to end the common practice of sending emergency care patients to hospitals sometimes 10 to 15 minutes out of the way. These diversions beget more diversions — once one hospital diverts an ambulance, a domino effect ensues. Under this system, patients often found themselves in hospitals where both their physicians and medical records were unavailable. Also, the patient could arrive at a hospital that was not in their insurance network. While health plans must cover emergency care, coverage for subsequent care varies from plan to plan.
"This is going to help everybody at the end," M. Riccardo Colella, DO, director of medical services for the Milwaukee County Office of Emergency Management, told the Journal Sentinel. "It is going to cause hospitals to be more efficiently lean, and patients will have a chance to go where they want go."
The implementation of this new policy required extensive preparation on the part of emergency departments and their hospitals.
Columbia St. Mary's Hospital Milwaukee hasn't diverted an ambulance since Feb. 17. To improve flow in the emergency room, the hospital's ED added beds and set up a triage area where a nurse practitioner or physician assistant can perform preliminary assessments and order tests. This way the results are readily available when a physician sees the patient.
Wheaton-Franciscan-St. Joseph in Milwaukee, the busiest ED in the state, stopped diverting ambulances on Feb. 1. To facilitate this difficult change, the health system hired Virginia Mason Institute in Seattle. Changes were implemented to speed admission, including the creation of a separate room to treat patients who exhibit no signs of needing emergency care.
Milwaukee-based Aurora Health Care made several process changes to improve patient flow in its hospitals' EDs, including sending X-rays from patients not in need of immediate care directly to radiologists instead of collecting them and sending them in batches. The ED has also increased the use of electronic reports to facilitate communication and hasten the care process.