"If you are followed primarily at one hospital and forced to go to another hospital that causes problems for patients. When one hospital is on diversion it causes problems for other hospitals," she says.
Diversion planning also forces hospitals to construct overly complicated Rube Goldberg-type contraptions designed for a strategy that doesn't work. "I talked to people who have been involved in diversion for a long time and they talked about this whole infrastructure created for diversion and when to go on diversion but it really doesn't solve the problem of crowding and it creates a lot of problems," Burke says.
Massachusetts imposed the ban on ambulance diversions after a decade-long study determined that "diversion has been shown to be ineffectual in addressing ED overcrowding, and its elimination is in the best interest of patient safety." Bay State hospitals are prohibited from diverting ambulances unless the ED is on "Code Black" status for contamination, fire, flooding, or other disasters that limit operations.
"Massachusetts hospitals have led and continue to lead the nation in finding ways to reduce ambulance diversion," says Anuj Goel, the Massachusetts Hospital Association's vice president of legal and regulatory affairs.
"In 2009, we were the first state to restrict the use of ambulance diversion by developing a collaborative environment for hospitals, physicians, ambulance companies and state regulatory agencies to find ways to address administrative and regulatory barriers to this effort. Today, we've moved beyond ambulance diversion to focus on patient flow for care provided before and after emergency department visits, to assist patients in our communities receive both timely and effective medically necessary care."