Study shows overcrowded EDs at hospitals with high volume of minority patients lead to ambulance diversion

Emergency department overcrowding is concerning for any patient who requires care. That said, it is particularly concerning for black heart attack patients, who are more likely than white patients to have their ambulance diverted from a crowded ED, according to new research in the journal BMJ Open.

The authors of the study compared daily ambulance diversion logs from 26 California counties between 2001 and 2011 to Medicare patient records with acute myocardial infarction. They categorized patients based on hours in diversion status for their nearest EDs on the day of admission. All total, they compared the diversion times for more than 29,900 Medicare patients.

They found hospitals serving a high volume of black patients spent more hours in diversion status than other hospitals. Patients served by a hospital in diversion status were less likely to be admitted to hospitals with cardiac technology compared with those facing no diversion.

Specifically, patients experiencing ambulance diversion were 4.4 percent less likely to be treated in a cardiac care unit, 3.4 percent less likely to be treated in catheterization labs or coronary artery bypass graft facilities, 4.3 percent less likely to receive catheterization and 9.6 percent more likely to die during the year a heart attack.

Renee Hsia, MD — an emergency medicine and health policy professor at the University of California, San Francisco, and one of the authors of the study — released a statement accompanying the research saying she hopes the findings will help make systemwide changes.

"While focusing efforts to decrease emergency department crowding is necessary in all hospitals, it might be more 'bang for the buck' if we want to make a dent in decreasing disparities by targeting efforts in minority-serving hospitals," Dr. Hsia stated.



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