The emergency department is the busiest area in a hospital, no matter the city. It is where patients go when they require immediate medical care, and it is staffed with critical care nurses and trauma physicians who are adept at handling patients needing acute care without a prior appointment.
These days, more emergency rooms are diverting patients to other hospitals because they are too full. As a result, ER diversion is starting to become a severe problem.
What is ER diversion?
Emergency Room (ER) Diversion happens when a hospital and its emergency room are overloaded to the point that they can no longer safely accommodate another patient. The hospital will declare itself on a "diversion" status, meaning that they cannot accept new ambulance arrivals until they can recover to what they deem is a safer time.
Some hospitals go on diversion for only an hour, some extend for several hours, and some even for days. The paramedics have no choice but to bypass a facility in favor of another one. While the alternate hospital is not obliged to honor the request, they usually accommodate the patient.
While ER diversion is common and happens in many cities across the country, the switch doesn't always go smoothly. In some cases, it results in grave consequences.
Why ER diversions happen
ER diversion has always been a controversial issue yet remains legal in most states, given how there's no policy that penalizes hospitals for asking ambulances to take patients elsewhere. When COVID-19 cases and hospitalizations are on the rise across the country, more and more hospitals report experiencing more significant difficulties transferring patients and are forced to divert them.
Vice president of public relations of the Missouri Hospital Association, Dave Dillion, posits that the biggest challenge causing the capacity problems is staffing. "The number of physical beds in hospitals is only as good as the staff you can put bedside," he noted. This issue is also nothing new, as critical care nurses' shortage is also a longstanding issue. Due to the shortage, there is an uptick in the number of patients who leave without being seen (LWBS) and those that have longer ER stays decreasing patient satisfaction.
Hospital administration must supply adequate critical nurse staffing that allows emergency rooms to improve the patient experience. After all, these nurses have received specialized training to accommodate those needing immediate care. Fortunately, this type of training is made more accessible due to the rise of remote learning.
There are now online RN to BSN programs that prepare nurses for critical care and for handling patients with life-threatening conditions. These are also very convenient as nurses can continue to work as they further their careers through accredited online courses. These advanced-practice nurses provide "intense and vigilant" care and the ability to think under pressure. These skills are now even more necessary in ER, where time is essential, and there is a lack of doctors.
Some believe that the key to diversions is merely adding more emergency rooms or hospital beds, but it's not that simple. Doing so without addressing the hospital's bottlenecks only temporarily solves the problem, it's only a matter of time when the hospital will become saturated again. If the number of staff isn't increased to match the increase in beds, this will make the problem much worse.
Ways to move forward
During this challenging time, the best course of action stems from the necessary level of individual responsibility. The public must not give up on the required precautions of keeping safe from COVID-19, like wearing masks, staying home, and maintaining social distancing. Until the vaccine has been allocated to most of the population, the best way the public can help hospitals is by protecting themselves.
Of course, hospitals must also continue to find ways to avoid the diversion status altogether. An individualized approach is recommended since no two hospitals are the same. Administrators must take the time to pinpoint bottlenecks and address them accordingly, like hiring additional staff and reworking scheduled to match patient demand better.
There are compounded issues behind ER diversions including staff shortages and a surge in cases needing immediate care. Some hospitals have adjusted by expanding their emergency waiting rooms and triage areas, others hired more staff. The everyday person can be just as accountable by putting in individual effort to stay out of the ER.
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