When a hospital is on diversion, it is a formal, temporary status indicating that the facility’s Emergency Department (ED) has reached a point of internal overload. The hospital requests that ambulances reroute to other medical centers. This status is a protective measure used by hospitals to manage resources when they are temporarily unable to provide timely or safe care for additional patients arriving via Emergency Medical Services (EMS) transport. The goal is to distribute the patient load across a regional healthcare system, preventing a total collapse of services at the strained facility.
What Hospital Diversion Means for Emergency Services
Hospital diversion status is a request directed specifically at Emergency Medical Services (EMS) personnel, primarily affecting patients being transported by ambulance, and the hospital communicates this status to local EMS coordinators and dispatch centers, asking them to bypass the facility. However, a hospital on diversion is never truly “closed” to emergency patients. The Emergency Department is legally required by the Emergency Medical Treatment and Active Labor Act (EMTALA) to remain open and must provide a medical screening examination and stabilizing treatment to anyone who arrives at its doors, meaning walk-in patients cannot be turned away. The distinction is purely operational, allowing the hospital to momentarily stem the flow of incoming ambulance traffic. If an EMS crew determines a patient is unstable or their condition is time-sensitive, they may still bypass the diversion request, and the hospital is obligated to accept the patient and initiate care immediately.
Primary Causes That Trigger Diversion Status
The decision to declare diversion is triggered by a severe mismatch between the hospital’s patient volume and its available resources, with capacity overload being the most common reason due to a lack of available inpatient beds throughout the hospital. When ED patients require admission but no beds are available, they remain in the ED, a phenomenon known as “boarding.” This boarding effectively ties up ED beds and staff, preventing the ED from accepting new patients from the ambulance bay. Staffing shortages also drive diversion, particularly a lack of nurses or specialized staff needed to maintain safe patient ratios. Less frequent causes include temporary infrastructure failures or internal disasters, such as the malfunction of a necessary piece of equipment like a CT scanner or the unavailability of an operating room for trauma or vascular cases.
How Diversion Affects Patient Care and Wait Times
For patients transported by ambulance, diversion results in an increase in transport time as the EMS crew must travel to the next nearest receiving facility. Studies have shown that this rerouting can increase travel time by an average of 1.7 to 5.0 minutes, which can be detrimental for time-sensitive conditions like stroke or severe trauma. The delay in reaching definitive care can lead to poorer outcomes for patients who require immediate intervention. Walk-in patients, while guaranteed treatment, experience the consequences of the underlying overload, facing significantly extended wait times to be seen, triaged, and treated; this strained environment can lead to patients leaving the ED before being seen, which is associated with poorer health outcomes. Furthermore, a single hospital’s diversion status creates a ripple effect across the regional healthcare system, quickly overwhelming neighboring hospitals and increasing their own patient volumes and wait times.