title: Collaborative to decrease ambulance diversion: the California Emergency Department Diversion Project.
abstract: BACKGROUND
  Ambulance diversion is a national problem that affects more than half of all emergency departments (EDs). Although diversion was meant to be used for short periods of time to offer temporary relief to EDs, it has evolved into a normal routine in many communities to manage the growing problem of ED and hospital crowding.
  
  
  OBJECTIVE
  To assess the impact of a collaborative effort to decrease ambulance diversion.
  
  
  METHODS
  This is a pre/post study investigating ED diversion in four emergency medical services agency regions in California from September 2006 through August 2008. Hospitals developed and implemented a number of best practices revolved around patient flow initiatives, specifically looking to improve input, throughput, and output. Monthly ED diversion data are compared and reported as means and standard deviations (SD).
  
  
  RESULTS
  During the study period, there were a total of 31,735 diversion hours in the collaborative regions, with 17,618 during the pre-consortium period and 14,117 in the post-consortium period (19.9% decrease). The monthly average hours of diversion before the consortium was 1468 (SD = 390.6). This decreased to 1176 (SD = 605.8) after the initiation of the consortium (difference of 292 h; 95% confidence interval 99-484; p = 0.007). There was a decrease in diversion hours for every month-to-month comparison except January and February (increases of 1% and 14.6%, respectively).
  
  
  CONCLUSIONS
  This study suggests that a decrease in ambulance diversion can be achieved through ongoing collaboration and the implementation of best practices. Continued communication and emphasis on diversion are likely needed to sustain these decreases.
authors.affiliation: Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California 92103, USA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Castillo
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.forename: Mike
authors.initials: M
authors.lastname: Williams
authors.forename: Pam
authors.initials: P
authors.lastname: Turner
authors.forename: Juliana
authors.initials: J
authors.lastname: Boyle
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data*; D002140:California; D016001:Confidence Intervals; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003441:Crowding; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011050:Policy Making; D018570:Risk Assessment; D013997:Time Factors