We recently published an issue brief and blog posts (here, here, and here) on ambulance diversions. That's when your local emergency room is so crowded that it temporarily shuts its doors to more ambulance traffic and sends patients elsewhere. So we noticed when today's Boston Globe reported that Massachusetts has ordered its hospitals to stop the practice by January 1.

The state's director of healthcare safety and quality Paul Dreyer said ambulance diversions may give ERs momentary breathing room but it doesn't solve the underlying problem of crowded emergency departments with patients backed up in hallways waiting for an open bed in the hospital.

To the contrary, he told the Globe's Liz Kowalczyk, diversion may create more problems than it solves, interfering with patient choice, increasing ambulance travel time (which can be dangerous) and just shifting the crowding to other hospitals. Instead of getting taken to the hospital where their doctor works and their records are kept, patients get taken to other hospitals where no one knows their medical history, prescription regimen etc. (Another argument for Health IT and records that doctors can access from any hospital but we digress).

"Undoubtedly this [ban on diversion] is going to be better for patients," Dr. Alasdair Conn, chief of emergency services at Mass. General told the Globe. "It makes no sense for a patient with 20 years of history at a hospital, where they had their surgery, where their EKG and other test results are, to have to go somewhere else." Last year Mass General was on diversion for the equivalent of almost a full month.

Dr. Conn said his hospital is focusing on ways to discharge patients from the hospital earlier in the day, thereby freeing up beds for patients waiting in the ER. That's one of the steps our colleague Dr. Guy Clifton recommended in the New America diversion paper and in other blog posts.

Dr. Brien Barnewolt, chairman of emergency medicine at Tufts Medical Center in Boston, said Tufts stopped temporarily closing its ER to ambulances in August to prepare for the change. Tufts has made several changes to free up beds to make room for patients who need to be admitted from the emergency department, including performing blood tests on overnight patients at 5:00 or 6:00 a.m. That way doctors can get test results and discharge patients earlier in the day, improving the patient flow.

We know that more efficient discharge procedures is only part of the solution, although one that can make a difference. Solving the overall emergency care crisis is more complicated. We need to cover the uninsured who turn to the ER as a last resort. We need to have better primary care to address more routine problems that don't belong in the ER. And we need to have better management of chronic disease, so that people don't end up having medical crisis that land them in the ER. In other words—we need comprehensive health reform.