ED Diversion Raises Heart Attack Mortality

Shen and Hsia noted that their data covered a period of time prior to the launch of emergency medical authority systems that direct patients to hospitals with operative and approved catheterization labs.

That may be one explanation for the difference.

Once admitted, patient treatment patterns differed in 2 dimensions, the report explains. The number of patients receiving catheterization when the nearest hospital was on diversion for 12 hours or more was 42% compared with 49% when the nearest hospital was not on diversion. The number of patients receiving percutaneous coronary intervention was 24% when the hospital was on diversion 12 hours or more, and 31% when the nearest hospital was not on diversion.

"When the closest ED was on diversion, a lower share of patients was admitted to hospitals with a catheterization laboratory (78% for those whose nearest hospital was on diversion 12 hours or greater compared with 87% for those in the no diversion category).

Diversion is a huge U.S. problem for hospital emergency departments. According to the National Center for Health Statistics, more than 500,000 ambulances a year, or one ambulance per minute, is diverted to a different hospital than the one closest to the patient's point of origin.

The researchers pointed out that emergency department diversions 12 hours or more "occurred in 25% of the daily logs. Notably, such long diversion hours are more likely to occur in winter and in densely populated metropolitan areas – both factors associated with increased ED demand."