I haven’t seen any discussion here about the recent memo the Mass Department of Health OEMS put out regarding ER diversion and EMS crews reaction. Although I work on an ambulance in Boston that responds to some emergencies, I have to admit, I don’t understand what’s going on.
Boston has the possibly unique situation that we have several Level I trauma centers all within close proximity, with several more Level IIs not far away. Beth Israel and Brigham and Women’s are literally blocks apart (and both Level Is), as well, Children’s Hospital Boston is another block away (a Pedi Level I). We have Mass General (A Pedi and adult Level I) less then three miles from that. In addition, there is Tufts Medical Center (and its floating hospital for children) that stands as a Pedi level I, and is fighting to receive accreditation as an adult level I. Lastly, there is Boston Medical Center (the old City Hospital, which merged with BU medical center East Newton campus, a block away), that is both an Adult and a Pedi Level I. Above is just what is within the city limits.
This super-saturation of medical capacity attracts many patients from outside MA looking for specialized care, but we still have a lot of acute beds to play with in the Boston area.
Mass General is the most often to go on divert, and according to the Boston Globe article cited below, it accounts for 35% of the over 1800 diver-hours last year.
In August, OEMS put out a directive saying that EMS crews no longer have to honor divert status from hospitals. See link below for more details:
http://www.mass.gov/Eeohhs2/docs/dph/emergency_services/specific_condition_point_of_entry_plan.pdf
Here is a Boston Globe Article from a few days ago giving a little more detail:
http://www.boston.com/news/local/articles/2008/09/13/state_orders_hospital_ers_to_halt_diversions/
and here is what a few medical bloggers have to say:
http://www.kevinmd.com/blog/2008/09/emergency-care.html
http://www.impactednurse.com/?p=553
http://tooldtowork.blogspot.com/2008/08/hospital-diversions.html
Again, I am looking to other Boston area EMTs to understand this problem. Is the end of diversions a good thing for patients? There has been discussion of what happens to medical records? How about for crews, who may have to wait at triage? How about for floor patients, who may be discharged prematurely to clear beds? How about ICUs?
How do other regions deal with this? Is this phenomenon specific to Boston? Is this a direct result of the move towards mass-insurance? Who is to blame here? Is this all because of ER misuse?
I know I am asking a lot of questions here, but I hope to spark some discussion and debate…
Boston has the possibly unique situation that we have several Level I trauma centers all within close proximity, with several more Level IIs not far away. Beth Israel and Brigham and Women’s are literally blocks apart (and both Level Is), as well, Children’s Hospital Boston is another block away (a Pedi Level I). We have Mass General (A Pedi and adult Level I) less then three miles from that. In addition, there is Tufts Medical Center (and its floating hospital for children) that stands as a Pedi level I, and is fighting to receive accreditation as an adult level I. Lastly, there is Boston Medical Center (the old City Hospital, which merged with BU medical center East Newton campus, a block away), that is both an Adult and a Pedi Level I. Above is just what is within the city limits.
This super-saturation of medical capacity attracts many patients from outside MA looking for specialized care, but we still have a lot of acute beds to play with in the Boston area.
Mass General is the most often to go on divert, and according to the Boston Globe article cited below, it accounts for 35% of the over 1800 diver-hours last year.
In August, OEMS put out a directive saying that EMS crews no longer have to honor divert status from hospitals. See link below for more details:
http://www.mass.gov/Eeohhs2/docs/dph/emergency_services/specific_condition_point_of_entry_plan.pdf
Here is a Boston Globe Article from a few days ago giving a little more detail:
http://www.boston.com/news/local/articles/2008/09/13/state_orders_hospital_ers_to_halt_diversions/
and here is what a few medical bloggers have to say:
http://www.kevinmd.com/blog/2008/09/emergency-care.html
http://www.impactednurse.com/?p=553
http://tooldtowork.blogspot.com/2008/08/hospital-diversions.html
Again, I am looking to other Boston area EMTs to understand this problem. Is the end of diversions a good thing for patients? There has been discussion of what happens to medical records? How about for crews, who may have to wait at triage? How about for floor patients, who may be discharged prematurely to clear beds? How about ICUs?
How do other regions deal with this? Is this phenomenon specific to Boston? Is this a direct result of the move towards mass-insurance? Who is to blame here? Is this all because of ER misuse?
I know I am asking a lot of questions here, but I hope to spark some discussion and debate…
h34r: