Nursing recruitment, better coordination cut diversions
These were some other key findings from the diversion study released recently by the Center for Studying Health System Change (HSC) in Washington, DC:
- The ongoing nursing shortage has played a significant role in diversions, and hospitals have redoubled efforts to fill nursing vacancies by turning to international recruiting and relatively costly agency or traveling nurses. Hospitals also have improved recruitment and retention of nurses by offering financial incentives and flexible work schedules.
- Growing physician unwillingness to provide emergency on-call coverage has contributed to diversions, and hospitals in six of the 12 communities studied have started to pay certain specialists for on-call coverage and, in some cases, compensate physicians for services provided to uninsured emergency patients to ensure adequate coverage and reduce diversions.
- Many hospitals have appointed bed czars to expedite patient flow through the hospital. Other strategies to speed bed turnover include improving housekeeping procedures to make sure newly vacated rooms are prepared quickly for incoming patients and adding new space for discharged patients to wait for transportation, which allows them to leave their rooms.
- Improved community coordination and oversight have helped stem diversions by improving communication across hospitals. Most of the 12 communities have updated or developed guidelines to define how long diversions can last, the types of patients or conditions deemed off limits from diversions, and the type of capacity limitations that warrant diversions.
- Some hospitals are employing more floor managers in the ED, often retired nurses, to mingle with patients in the waiting area and improve the flow through triage and treatment. The floor managers can help ensure that serious issues are not overlooked in the triage process, answer questions, and assist various staff with their tasks depending on what is needed at the moment.