title: A novel diversion protocol dramatically reduces diversion hours.
abstract: BACKGROUND
  Ambulance diversion is a problem in many communities. When patients are diverted prompt and appropriate medical care may be delayed.
  
  
  OBJECTIVE
  Compare diversion hours and drop-off times before and after a dramatic change in diversion policy restricting each hospital to 1 hour out of every 8.
  
  
  METHODS
  This study was a retrospective study in a county of 600,000 people and 10 hospitals from September 2004 to February 2006. A countywide diversion protocol was implemented in March 2005 that limited diversion hours to 1 hour out of every 8 (maximum of 90 h/mo). No other changes were implemented during the study period. Pretrial (9/04-2/05), interim (3/05-8/05), and posttrial (9/05-2/06) periods were compared. The main outcome measures were ambulance diversion hours and emergency medical service (EMS) drop-off times. Results were compared using analysis of variance and a Tukey post hoc analysis. P < .05 was considered significant.
  
  
  RESULTS
  There was no significant difference in the number of monthly transports comparing the posttrial vs pretrial periods; however, a significant decrease in monthly ambulance diversion hours (difference, 251 hours; 95% CI, 136-368) and significant increase in additional time that EMS crews required to transport patients (drop-off times) (difference, 178 hours; 95% CI, 74-283) were observed. Posttrial diversion hours decreased to 18% of the pretrial values (from 305 to 54).
  
  
  CONCLUSIONS
  This novel ambulance diversion protocol dramatically reduced diversion hours at the cost of increasing EMS drop-off times in a large community.
authors.affiliation: Department of Emergency Medicine, University of New Mexico, Albuquerque, NM 87131-0001, USA.
authors.forename: Osei Kwame
authors.initials: OK
authors.lastname: Asamoah
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Weiss
authors.forename: Amy A
authors.initials: AA
authors.lastname: Ernst
authors.forename: Michael
authors.initials: M
authors.lastname: Richards
authors.forename: David P
authors.initials: DP
authors.lastname: Sklar
mesh_terms: D000552:Ambulances; D000704:Analysis of Variance; D003441:Crowding; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D009516:New Mexico; D010360:Patient Transfer / Q000458:organization & administration*; D012189:Retrospective Studies; D013997:Time Factors