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New Report Says Ambulance Diversions are Just another Symptom of a Struggling Health System

Communications — Thu, 04 Sep 2008 08:39:00 -0400

U.S. hospitals routinely turn ambulances away in an emergency -- further proof that our health system is in need of comprehensive reforms, according to a report released today by the Health Policy Program at the New America Foundation.

In the report entitled, "Ambulance Diversions: What They Are, Why We Care, and What To Do," Guy Clifton, MD, neurosurgeon and Physician Advisor to the New America Foundation, suggests that ambulance diversions are a result of an increased reliance on Emergency Departments (EDs) for primary care (especially by the uninsured), inefficiencies in hospital practice, and bed capacity that is inadequate or unstaffed.

"The pervasiveness of ambulance diversions puts us all at risk. Comprehensive health reforms that both incentivize hospitals to improve the quality of their practice and ensure all Americans have health coverage, would reduce the frequency of ambulance diversions and make sure our emergency system functions at its highest level when patients need it the most," said Dr. Clifton.

"Ambulance diversions are further evidence that covering all Americans is a necessary step towards improving the quality of patient care in the U.S.," Clifton continued.

An ambulance diversion occurs when a hospital ED cannot care for additional emergency patients. When a hospital is "on diversion" it redirects ambulances from their ED to another hospital or medical facility. One ambulance is diverted every minute in the U.S. according to the Institute of Medicine.

"Ambulance Diversions: What They Are, Why We Care, and What To Do"

Ambulance diversions pose a health threat to Americans needing emergency care. Anyone, regardless of insurance status, can be diverted from a hospital in an emergency. Ambulance diversions impact both emergency trips to the hospital and transports from one hospital to another.
Standardizing ambulance diversion criteria and covering the uninsured could help reduce ambulance diversions. Standard criteria for when a hospital can put itself on diversion should be established and adopted by all hospitals. These criteria might include: percentage of hospital beds currently in use; the number of staff on duty; and, the number of people in the ED waiting room.

The large number of uninsured patients causes increased strain on already over-taxed emergency departments. Making sure all Americans have quality, affordable health coverage will help keep patients out of the hospital for non-emergent treatment and allow EDs to function more efficiently.

For more information visit the New Health Dialogue blog at www.newhealthdialogue.org .

Contact:
Elizabeth Carpenter
New America Foundation
401-529-9379 (cell)
202-986-2700 (office)
carpenter@newamerica.net

Ambulance Diversions

Health Policy — Wed, 03 Sep 2008 08:26:00 -0400

Every minute in the United States, an ambulance is turned away from a hospital because of a practice known as ambulance diversion. Diverting ambulances away from emergency departments (EDs) poses a serious threat to the health outcomes of both the insured and uninsured population. Ambulance diversions also indicate a struggling health system in need of comprehensive delivery system reforms.

What is an Ambulance Diversion?

An ambulance diversion occurs when a hospital ED cannot care for additional emergency patients. When a hospital is “on diversion” it redirects ambulances from their ED to another hospital or medical facility.

Why Do Diversions Matter?

Ambulance diversions pose a health risk to anyone who needs immediate medical attention. Furthermore, ambulance diversions are an indication that individuals are using EDs for their primary care, and that hospitals have inadequate bed capacities, and/or are being poorly managed.

What Can We Do to Fix This Problem?

There are two major possible policy solutions for ED diversion:

Standardizing Ambulance Diversion Criteria
Covering the Uninsured

For the full text of the issue brief, click here.

IHS Reforms Long Overdue

Cecille Isidro — Mon, 27 Aug 2007 13:19:00 -0400

On the Crow Indian Reservation this month, U.S. Sen. Byron Dorgan (D-ND), and Sen. Jon Tester (D-MT), led a hearing of the Senate Indian Affairs Committee, addressing the severe lack of federal funds and management for the Indian Health Service. IHS officials, including acting chief medical officer Dr. Charles North, and tribal members testified to the shortage of qualified health professionals, closure of health facilities and cancellation of programs midway through the fiscal year.

A bipartisan collection of senators primarily from the Senate Indian Affairs Committee are co-sponsoring legislation that would foster improvement within IHS. These changes would include, for example, outreach and enrollment for those eligible for public coverage under programs like SCHIP; cancer screenings; school health programs; and the maintenance and improvement of facilities.

High Needs, Low Resources

IHS needs reform. IHS serves approximately 1.5 million of the 3.1 million American Indian and Alaska Natives from roughly 560 federally recognized tribes. In addition to underfunded facilities, death and disease rates among natives continue to exceed those of the general public -- with diabetes and suicide rates double those of white Americans. These and conditions such as alcoholism, depression and heart disease plague reservation communities.

Inadequacies in coverage, care and facilities are so great that the Census Bureau’s current population survey does not consider American Indian and Alaska Natives "covered" under IHS -- more than a third of American Indian and Alaska Natives went without suitable coverage in 2004. This makes them part of the nearly 47 million Americans without health insurance. In 2004, only 15.5 percent of native adults received medical treatment of any kind. Lack of enrollment in public programs and inadequate services contribute to this predicament. Having access to facilities is not enough.

Navajo Model

Opponents to IHS would prefer to see the Indian Health Care Improvement Act expire. As a more tightly managed agency, however, IHS has the potential to be a leader in culturally specific, community-centered care, in a country with wide variation and regional differences. Glimpses of its promise can be seen in places like the Four Corners region of the U.S. (New Mexico, Arizona, Utah and Colorado). The Navajo Nation, which is the largest Indian tribe in the United States, with the largest reservation of more than 25,000 square miles, has the IHS’s Navajo Division of Health. Though the NDOH suffers from a lack of funds, it is able to provide a variety of services that are tailored to the community and serve needs that would otherwise go unmet.

Reauthorization of the Indian Health Care Improvement Act could accomplish several feats, now and in the future. Turning IHS into a system that is well-managed and adequately funded could reduce the number of uninsured Americans. Establishing mental and personal health programs (with trained professionals) could improve overall health of communities and contain costs. Finally, giving IHS the opportunity to reach the heights of the VA would lay the groundwork for comprehensive health reform that preserves specialized care for unique populations.

This is a promise our government made to American Indian and Alaska Natives -- to provide resources for their well-being. For the past 15 years, Congress has let IHS go unchecked and underfunded. Reauthorization has failed several times in the last decade. Keeping the Indian Health Care Improvement Act alive, along with oversight and skilled management, could put IHS back on course for providing quality care and services to the first Americans.