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ACEP Chief Rails Against ED Diversions, Scheduling

Cheryl Clark, for HealthLeaders Media, June 16, 2011
Time indeed equals muscle. That sobering fact was underscored by news this week that three additional heart attack patients in every 100 will die of preventable complications if their blockage unfortunately occurs on the day the nearest ED is on ambulance diversion.

It's a fact that hospitals and policy makers should not ignore.

This alarming statistic about ED overcrowding – and others equally grim – came from a large population study published this week in the Journal of the American Medical Association. The research paper gives Sandra Schneider, MD, president of the American College of Emergency Physicians and an ED doc at Strong Memorial Hospital in Rochester, N.Y. a chance to make some additional points about how the system must change to save lives.

For starters, hospital executives and consumer groups need to realize that it's not just heart attack patients who are more likely to die when EDs are on diversion, she says. It's patients with any critical illness – pneumonia, stroke, injuries or wounds from violence, "or any other condition where it's important to get treatment early." The circumstance of diversion has implications for patients who were already admitted to the hospital that sends ambulances elsewhere, because chances are staff is already too strapped to provide them with optimal care, she says.


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Additional studies should document the casualties of those other medical conditions as well, she suggested.

When I asked her to comment on the JAMA study this week, Schneider seemed to not want to get off the phone. "I'm passionate about this because I'm the one who has to watch patients die," she says. "There's absolutely no question in my mind, and the mind of every emergency physician out there, that holding inpatients in the emergency room and backing things up … leads to ambulance diversion. It's just bad. It causes death; it causes delays in care; it causes increased discomfort."

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1 comments on "ACEP Chief Rails Against ED Diversions, Scheduling"


Sam Breneiser (6/16/2011 at 7:55 PM)
Thank you for the very good article on E D crowding and issues. Since the newsletter indicates you are in California, I am curious of you mentioned our legislated staffing ratios to Dr Schneider? Here in California hospitals are barred from the choice of flexibility the two of you advocate in the article. To that extent I think you missed an opportunity to point out that excessive health care regulation is also not the solution – it is not the "health care system" of the U.S. that [INVALID]d those regulations, it was very well meaning but deeply misguided legislators – the legal and political system - that imposed those rules here in California. I think your point was that in order to improve health care outcomes we all need to pull our heads out of our respective standard operating procedure boxes and engage in creative thinking to respond appropriately. I just don't agree that its solely the health care system causing the problem, nonetheless it is ours to clean up.