Can your ED duplicate San Diego’s success?
Could an ambulance diversion program work in your area? The answer is yes, according to one ED manager who co-chaired the San Diego Emergency Medical Service (EMS) Medical Oversight Committee (EMOC) that created a successful new diversion program in San Diego County.
’I don’t think there’s anything that special or unique about our community,” says Gary Vilke, MD, medical director for San Diego County EMS, associate professor of clinical medicine at the University of California San Diego (UCSD), and an attending physician in the UCSD Medical Center ED. ’If it were a smaller group of hospitals, it would still work the same,” he points out.
For ED managers looking to drive such an effort, gather the EDs together and develop a common goal and mission, Vilke advises. ’Everyone has got to win,” he asserts. ’If there is something that is detrimental for one member of the group, you have to make it win’ for them, too.”
The San Diego program required, among other things, that hospitals accept patients originally discharged from their facility, regardless of diversion status. The only problem that arose in San Diego involved EMS ambulances, says Ray Poliakoff, MD, chief of emergency medicine at Kaiser Permanente in San Diego.
There are EMS regulations that prohibit ambulances from going past certain distances, Poliakoff notes. ’Some ambulances did not want to go an extra 10 minutes, abandon areas they were basically paid for, without knowing how they would be covered,” he says.
Also, there was a lot of concern about offloading delays, if every ambulance inundated one hospital but it did not work out that way, Poliakoff says. ’When everyone took their’ patients, it turned out you didn’t get any more burdened,” he says.
The pre-hospital agencies did have concerns with occasional offload delays, as the hospitals were focused on getting their own patients, Vilke adds. ’But when the issue was brought to the EMOC meeting, the hospitals were asked to individually troubleshoot the situation, work with their agencies, and then ultimately the problem corrected.”
To give your project a strong chance for success, ’You have to demonstrate the problem, define it, get data to support it, and find a champion or two,” he says. ’Every state has a medical society, but there are usually also county and local societies that can help you, too.”
Vilke notes that the original data on the total number of diversion hours in the area, which demonstrated the depth of the diversion problem, was provided by San Diego County. In addition, he points out, it was the San Diego County Medical Society that recognized the seriousness of the problem and established the EMOC.
Could an ambulance diversion program work in your area? The answer is yes, according to one ED manager who co-chaired the San Diego Emergency Medical Service (EMS) Medical Oversight Committee (EMOC) that created a successful new diversion program in San Diego County.Subscribe Now for Access
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