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Hospital Survey Sheds Light on Diversions

The Schumacher Group, a national hospital ED management firm responsible for the clinical staffing and operation of more than 90 acute-care hospital EDs in the U.S., has completed its fourth annual survey of ED administrators. The survey is offered as a benchmark for healthcare professionals to use to set ED staffing policies, evaluate current operational procedures and track emergency medicine trends.

Of 4,000 surveys mailed out in October 2003, 681 were returned by mid-November, for a response rate of 17%. One focus of the survey of interest to prehospital providers was on hospital diversion.

Sixty-eight percent of ED administrators surveyed indicated that patient volumes increased in the past 12 months. Eighteen percent indicated that overcrowding, due to increased patient volume, had caused them to divert patients to other hospitals; however, that number was down from 36% in a 2001 survey. Schumacher speculates that the decrease may be because many hospitals have expanded their EDs in response to rising patient numbers and are better able to handle higher volumes.

Surprisingly, the lack of specialty coverage seems to be driving patient diversions at most facilities. Of those surveyed, 76% indicated that lack of physician speciality coverage was responsible for diversions—up 65% from 2001—and 23% believed the lack of specialty coverage posed a significant risk to their ED patients. An increasing shortage of specialists has made ED coverage more difficult; and rising malpractice rates and uncompensated care make some specialists reluctant to cover the ED. In fact, 15% of the administrators said they would go to a facility other than their own in the event they were seriously injured—primarily (73%) due to the lack of specialty backup in their own ED.

Of those surveyed, 77% said their ED is a major provider of primary care for the indigent/uninsured in their community; more than 50% of the patients visiting a local ED were classified as nonemergent.

Finally, more than one-fifth (22%) said that HIPAA has detracted from the quality of care they are able to provide in their EDs; 8% said HIPAA has enhanced the quality of care in their EDs; and 69% indicated that HIPAA has had no effect on their quality of care.

—MN

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