The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #71970

Edward M. Castillo, PhD, MPH¹, Gary M. Vilke, MD¹, Leslie Upledger Ray, MA, MPPA¹, Barbara M Stepanski, MPH¹, Alan M Smith, MPH¹, Theodore C. Chan, MD², and Patricia M Murrin, RN, MPH¹. (1) Health and Human Services Agency, Division of Emergency Medical Services, County of San Diego, 6255 Mission Gorge Rd, San Diego, CA 92120, (619) 285-6429, edward.castillo@sdcounty.ca.gov, (2) Emergency Medicine, University of California, San Diego Medical Center, 6255 MIssion Gorge Rd, San Diego, CA 92120

Purpose: Pediatric patients who are responded to via the 911 system benefit from being delivered by ambulance to their requested facility where they typically received care. This allows for access to primary care physicians and records and eliminates additional medical procedures and subsequent time consuming interfacility transfers. This study documents the change in pediatric patient diversions due to revised patient transport and emergency department (ED) bypass practices.

Methods: Beginning October 1, 2002, hospitals and ambulance agencies implemented revised ambulance diversion practices that were designed to limit emergency patient diversion and ED bypass. Data was collected from October 1, 2001 through January 31, 2003 to document the changes in ambulance diversion for pediatric patients < 20 years of age.

Results: There was a monthly average of 1086 advanced life support pediatric transports during the year prior to ambulance diversion changes. A monthly average of 114 (10%) patients were diverted from their requested facility during this time. There was a monthly average of 32 diverted patients during the four months after the new transport practices were in place, which was a 72% reduction. The monthly average hours on ED bypass decreased from 4007 to 1311 hours after practice changes among the 21 active EDs, which is a 33% reduction.

Conclusions: The reasons for ambulance diversion due to ED bypass are multifactorial. New ambulance diversion practices have successfully decreased the number of diverted pediatric patients allowing more to get to their primarily requested facility.

Learning Objectives:

• 1.Understand reasons for emergency department bypass and ambulance diversion.
• 2.Be aware of recent trends in emergency department bypass and ambulance diversion.
• 3.Be aware of methods used to decrease emergency department bypass hours and ambulance diversion.
• 4.Recognize benefits from decreasing emergency department bypass hours and ambulance diversion.

Keywords: Pediatrics, Emergency Department/Room

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.