Our local EMS governing agency has decided that hospitals within their jurisdiction will not be allowed to go on diversion. This starts in about a month. Anyone else work in a ER that cannot go on diversion?

Any interesting note is that we are so busy, diversion at least once is a day is a normal occurrence.

Thanks!

-Mark

It helps if I spell the word "diversion" correctly.

OH WOW, I couldn't imagine my hospital not being able to go on diversion. We are the only level one trauma center in my city and at times everyone is in resess and theres about 3 nurses for 35 Pt's which is not very safe. I think that is a recipe for a disaster.

we don't divert often but sometimes we are so crazy its unsafe .i wouldn't like that policy its not their license on the line.

For financial reasons, i.e. they want the "customers" our hospital has instituted a "no diversion" policy this past year. They opened up a holding area, and sometimes the floors have to take patients they are ill staffed to take care of. The one time it got bad was when there were 11 critical care holds int he ER. We used to go on divert several times a week and now never.

However, it's nice that no law is dictating this to us, it's an internally driven policy. So technically we can still go on divert, and hopefully will if it gets too bad.

What are they going to do when nurse patient ratios like California finally get filtered down nation wide. I can wait to see every medic crew in the county waiting on the dock for a free nurse to take his or her patient. I know a traveler who tells me at shift change they reverse triage pts to the lobby to get the nurses to 3:1.

R

We do not divert, never have been able to as long as I have worked there (over 2 years). It's not always safe, it's not always fun but we muddle thru it in then end.

But we are not a trauma center - we are a small rural ER who has to ship out patients we can not treat.....so if we ever diverted, we would be patientless and $$$$less.

But we've had days where EMS has to wait to find a bed and an RN to accept their patient.....

funny thing about diversion: everyone makes a big deal about it, yet it realy has very little power.

it doesn't stop patients from driving themselves to the hospital.

it doesn't stop ems from bringing the true emergenices in (those that they have to transport to the closest facility)

it doesn't stop ems from bringing in the patients that say "i don't care if they are on diversion, i want to go to that hospital."

we sometimes spend a whole lot of time jumping through a whole lot of hoops trying to get administration to ok us to go on divert........with very little impact.

are these things different elsewhere?

the one things it does do is let everyone know that your facility is bursting at the seems. it may help in a legal scenerio if there is a bad outcome due to the oversaturation.

What are they going to do when nurse patient ratios like California finally get filtered down nation wide. I can wait to see every medic crew in the county waiting on the dock for a free nurse to take his or her patient. I know a traveler who tells me at shift change they reverse triage pts to the lobby to get the nurses to 3:1.

R

We are in California, so we are supposed to be at 4 to 1. This will be an issue obviously.

The other interesting fact is that there is a hospital about 10 miles down the road from us that is in a different county, so they aren't governed by this same EMS agency. They CAN go on diversion, and often do, to the tune of 3 times a day every day. We get all their diversion traffic. So we will have to take all of their traffic plus ours.

What are they going to do when nurse patient ratios like California finally get filtered down nation wide. I can wait to see every medic crew in the county waiting on the dock for a free nurse to take his or her patient. I know a traveler who tells me at shift change they reverse triage pts to the lobby to get the nurses to 3:1.

R

Do you really think they'll end up doing that nation wide? I'm not very optimistic about this happening. There is too much opposition to it......on the part of the hospitals. It would be nice, but I'm not very optimistic about it happening.

I think it is a very poor decision on the part of the EMS governing agency. ERs come in all different sizes and capabilities. Also some doctors are much faster than others. When I worked in the ER, we asked for diversion whenever we started feeling we were unable to safely care for the patients we had. This was based on the nurses and doctor's assessment of the situation we were in. I think it is very unfair for anyone else to make that decision.

Of course I worked in a very small ER. Larger hospitals have better capabilities and more resources. Being on diversion sometimes didnt stop EMS from bringing patients in, but often they waited for hours until a bed came open. I would never bump someone in the waiting room who had been there longer with the same triage classification.

No matter how bad things get, we are not allowed to go on bypass. Never, never. Have worked with no electricity and still no bypass.

When my ED goes on diversion, we get ambos from other counties, which makes no sense. I would rather have our local EMS come here, even if we are on yellow, than have surprise visits from other locales. And patients & their families would rather not have to drive to a different hospital where they don't know the Docs.