Elimination of Emergency Department Ambulance Divert during the COVID-19 Pandemic Was Not Associated with an Increase in the Average Number of Ambulance Arrivals per Day

Abstract

Introduction

During the COVID-19 pandemic, ambulance divert in our EMS system reached critical levels. We hypothesized that eliminating ambulance divert would not be associated with an increase in the average number of daily ambulance arrivals. Our study objective was to quantify the EMS and emergency department (ED) effects of eliminating ambulance divert during the COVID-19 pandemic.

Methods

Regional hospital divert data were obtained for the 10-county Twin Cities metro from MNTrac, a state-supported online system designed to allow hospitals to indicate their divert status to EMS. ED metrics are reported for a single Level I trauma center and were obtained by a deidentified data pull from our electronic medical record covering the 12 months prior to the elimination of divert (2021) and the 12 months after divert elimination (2022). The decision to eliminate divert occurred in November 2021, based on data available through October, with an implementation date of January 2022. The primary study outcome was to quantify the effect of the elimination of divert on the number of ambulances arriving per day at the study hospital.

Results

Regional utilization of ambulance divert increased steadily by 859% from January to October 2021 when 355 individual divert events occurred, totaling 809 h (34 days). There was no significant difference in the number of ambulances that arrived to the study hospital in 2021 (30,774) vs 2022 (30,421) p = 0.15. As compared to 2021, in 2022 there was no significant increase in mean ambulance arrivals per day (84/day vs 83/day, p = 0.08), time to room Emergency Severity Index level 2 (ESI) patients (28 min vs 28 min, p = 0.90), or time to obtain emergent head CT in acute “code stroke” patients (12 min vs 12 min, p = 0.15). Ambulance turnaround interval in the ED did not appreciably increase (16 min vs 17 min, p = 0.15).

Conclusion

Elimination of ambulance divert was not associated with increases in the number of mean daily ambulance arrivals or EMS turnaround intervals, delays in ESI 2 patients being placed in beds, or prolonged time to head CT in stroke code patients.

Authors Contributions

Aaron M. Burnett contributed to Study conception, prepared manuscript, analyzed data, study design; Kari B. Haley contributed to methodology, analysis of data. Assisted with review and revision of the manuscript; Matthew F. Milder contributed to project development, implementation, data analysis and interpretation; Bjorn K. Peterson contributed to methodology, analysis of data. Assisted with review and revision of the manuscript; Joey Duren contributed to methodology, analysis of data. Assisted with review and revision of the manuscript; Andrew Stevens contributed to methodology, analysis of data. Assisted with review and revision of the manuscript; Danielle M. Hermes contributed to data collection and tabulation, project management; Paul Nystrom contributed to methodology, analysis of data. Assisted with review and revision of the manuscript; Joseph Lippert contributed to project implementation and oversight, data analysis; Jennifer L. Moberg contributed to project implementation, staff training, data collection; Kurt M. Isenberger contributed to project advocacy, analyzed data, study design, manuscript development

Disclosure statement

No potential conflict of interest was reported by the author(s).