The effect of an ambulance diversion ban on emergency department length of stay and ambulance turnaround time.
OBJECTIVE
Massachusetts became the first state in the nation to ban ambulance diversion in 2009. It was feared that the diversion ban would lead to increased emergency department (ED) crowding and ambulance turnaround time. We seek to characterize the effect of a statewide ambulance diversion ban on ED length of stay and ambulance turnaround time at Boston-area EDs.


METHODS
We conducted a retrospective, pre-post observational analysis of 9 Boston-area hospital EDs before and after the ban. We used ED length of stay as a proxy for ED crowding. We compared hospitals individually and in aggregate to determine any changes in ED length of stay for admitted and discharged patients, ED volume, and turnaround time.


RESULTS
No ED experienced an increase in ED length of stay for admitted or discharged patients or ambulance turnaround time despite an increase in volume for several EDs. There was an overall 3.6% increase in ED volume in our sample, a 10.4-minute decrease in length of stay for admitted patients, and a 2.2-minute decrease in turnaround time. When we compared high- and low-diverting EDs separately, neither saw an increase in length of stay, and both saw a decrease in turnaround time.


CONCLUSIONS
After the first statewide ambulance diversion ban, there was no increase in ED length of stay or ambulance turnaround time at 9 Boston-area EDs. Several hospitals actually experienced improvements in these outcome measures. Our results suggest that the ban did not worsen ED crowding or ambulance availability at Boston-area hospitals.
Beth Israel Deaconess Medical Center, Boston, MA, USA. lgburke@bidmc.harvard.edu
Laura G
LG
Burke
Nina
N
Joyce
William E
WE
Baker
Paul D
PD
Biddinger
K Sophia
KS
Dyer
Franklin D
FD
Friedman
Jason
J
Imperato
Alice
A
King
Thomas M
TM
Maciejko
Mark D
MD
Pearlmutter
Assaad
A
Sayah
Richard D
RD
Zane
Stephen K
SK
Epstein
D000552:Ambulances / Q000458:organization & administration / Q000706:statistics & numerical data*; D001900:Boston; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D006291:Health Policy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000458:organization & administration; D012189:Retrospective Studies; D013997:Time Factors