Ambulance Diversion and Emergency Department Offload Delay: Resource Document for the National Association of EMS Physicians Position Statement

Figures & data

Figure 1.  Depiction of factors leading to ambulance diversion as described by Pham et al. CT = computed tomography; ED = emergency department; ICU = intensive care unit; OR = operating room; PCI = percutaneous coronary intervention. Reproduced with permission from: Pham JC, Patel R, Millin MG, Kirsch TD, Chanmugam A. The effects of ambulance diversion: a comprehensive review. Acad Emerg Med. 2006;13:1220–7. Permission granted through Rightslink Copyright Clearance Center #2695501083760.

Table 1.  Key Publications Related to Ambulance Diversion

Study	Key Point(s)
Lagoe and Jastremski, 1990^17	Described diversion as a novel approach to alleviating ED crowding.
Scheulen et al., 2001^18	Diversion had some limited effect on ED crowding in urban and suburban areas, and no effect in rural EDs; impact of alert policies may change over time.
Lagoe et al., 2002^19	Diversion was noted to have become common, and the citywide diversion rate was around 51%.
Lagoe et al., 2003^20	Showed that hospital administration response to diversion could lower diversion rate.
Pham et al., 2006^21	Diversion was associated with ED crowding and increase in patient transport and treatment times without significant increase in morbidity/mortality; the rate may be reducible through redesign or addition of resources.
Asamoah et al., 2008^26	A strict diversion policy led to a decrease (82%) in diversion but an increase (32%) in ambulance offload delay.

ED = emergency department.

Figure 2.  Spaite model of emergency medical services time interval with additions by Cone et al.³¹ ED = emergency department. Reproduced with permission from: Cone DC, Davidson SJ, Nguyen Q. A time–motion study of the emergency medical services turnaround interval. Ann Emerg Med. 1998;31:241–6. Permission granted through Rightslink Copyright Clearance Center #2695510126593.

Lagoe RJ, Jastremski MS. Relieving overcrowded emergency departments through ambulance diversion. Hosp Top. 1990;68(3):23–7.

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Scheulen JJ, Li G, Kelen GD. Impact of ambulance diversion policies in urban, suburban, and rural areas of central Maryland. Acad Emerg Med. 2001;8:36–40.

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Lagoe RJ, Hunt RC, Nadle PA, Kohlbrenner JC. Utilization and impact of ambulance diversion at the community level. Prehosp Emerg Care. 2002;6:191–8.

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Lagoe RJ, Kohlbrenner JC, Hall LD, Roizen M, Nadle PA, Hunt RC. Reducing ambulance diversion: a multihospital approach. Prehosp Emerg Care. 2003;7:99–108.

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Pham JC, Patel R, Millin MG, Kirsch TD, Chanmugam A. The effects of ambulance diversion: a comprehensive review. Acad Emerg Med. 2006;13:1220–7.

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Asamoah OK, Weiss SJ, Ernst AA, Richards M, Sklar DP. A novel diversion protocol dramatically reduces diversion hours. Am J Emerg Med. 2008;26:670–5.

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Cone DC, Davidson SJ, Nguyen Q. A time–motion study of the emergency medical services turnaround interval. Ann Emerg Med. 1998;31:241–6.

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