No diversion in Western Massachusetts

Area of Science:

• Health Services Research
• Emergency Medicine
• Healthcare Policy

Background:

• Massachusetts implemented a statewide moratorium on ambulance diversion, termed "No Diversion," effective January 1, 2009.
• This policy aimed to improve patient access to emergency care by preventing hospitals from diverting ambulances.

Purpose of the Study:

• To evaluate the impact of the "No Diversion" policy on key Emergency Department (ED) throughput measures.
• To determine if the absence of ambulance diversion affected patient flow dynamics in Massachusetts EDs.

Main Methods:

• A comparative analysis of three 3-month periods: one year prior, three months prior, and three months after the policy implementation.
• Utilized mixed-effects regression models to compare mean monthly throughput metrics (volume, admissions, elopements, length of stay) across "all," "high" diversion, and "low" diversion ED groups.
• Defined clinical significance based on consistent and statistically significant differences (p ≤ 0.01) between pre- and post-policy periods.

Main Results:

• No clinically significant changes were observed in mean monthly patient volume across any ED group.
• The number of admissions, patient elopements, and length of stay did not show significant changes post-policy.
• Analysis revealed no significant impact on throughput measures for "all," "high" diversion, or "low" diversion EDs.

Conclusions:

• The "No Diversion" policy in Massachusetts was not associated with significant improvements or changes in ED throughput.
• Findings suggest that eliminating ambulance diversion alone may not substantially alter ED patient flow dynamics.
• Further research may be needed to explore other factors influencing ED throughput.