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The impact of an ED-only full-capacity protocol
Taketo Watase1, Rongwei Fu, Denise Foster
1Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, OR, USA. wataset@ohsu.edu
The American Journal of Emergency Medicine
|November 22, 2011
Summary
Implementing an emergency department (ED) full-capacity protocol significantly reduced ambulance diversion rates. This simple, ED-based strategy proved effective in managing patient flow and decreasing diversion occurrences.
Area of Science:
- Emergency Medicine
- Healthcare Management
- Quality Improvement
Background:
- Emergency departments (EDs) frequently experience overcrowding, leading to ambulance diversion.
- Diversion protocols aim to manage patient surges but can impact access to care.
- The effectiveness of ED-specific, full-capacity protocols needs rigorous assessment.
Purpose of the Study:
- To evaluate the impact of an ED-only full-capacity protocol on ambulance diversion.
- To control for patient volume and other confounding factors in assessing protocol effectiveness.
- To determine if the protocol reduces the rate of ED diversion.
Main Methods:
- A preintervention and postintervention cohort study design was employed.
- Data were collected for 12 months before and 12 months after protocol implementation.
- A multivariate logistic regression model analyzed ambulance diversion rates between the two periods.
Main Results:
- The proportion of days with at least one diversion event decreased from 60.4% preimplementation to 20% postimplementation (P < .001).
- The full-capacity protocol was significantly associated with reduced odds of diversion (OR, 0.32; 95% CI, 0.21-0.48).
- The protocol demonstrated effectiveness independent of patient volumes and other potential confounders.
Conclusions:
- An ED-only full-capacity protocol is a straightforward and adaptable strategy.
- This protocol can be implemented within the ED's existing framework.
- The strategy is significantly linked to a reduction in ED diversion rates.
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