S: Hospital challenges including prolonged wait times, ED admit holds, and increased length of stay are worsening. While the reasons are multifactorial, it has created a situation in which hospital diversion hours have increased month over month with no signs of improvement. Hospital diversion creates challenges for EMS and police with regards to hospital destination decisions and for hospital staff as to what diversion means.
B: Diversion is a status requested by a hospital to the emergency dispatch center when it is experiencing higher than normal volume/acuity. This may be related to increased patient arrivals or maintaining admitted hold patients in ED beds. EMS may experience extended transfer of care / off-load times in these situations. Diversion is primarily designed to provide situational awareness to EMS providers and other first responders as to conditions at a hospital emergency department. Diversion is a courtesy and does not mean that the emergency department is closed or not able to receive patients. The EHS office has spent time to provide additional education to all stakeholders on what diversion is and how it is best integrated into the emergency care system. This has included a regional FAQ document and discussions in multiple venues (EMS Chiefs Association, Health Council, MAC meetings). There is a continued lack of understanding by many on what diversion means and how it should be integrated into hospitals plan for managing excess volume / surge situations. At no time should a patient be turned away or refused by a hospital when they have requested divert status.
A: Inconsistency of diversion requests among facilities with a misunderstanding of what diversion means has led to a patient safety issue. EMS providers and other first responders are left unsure which facilities they may transport patient’s to, especially when multiple hospitals request divert at the same time. Some hospitals believe that diversion secondary to excess volume / surge is closure and may request EMS providers and other first responders bypass them. This is not the intent of diversion and places patients at increased risk of refusing EMS transport, prolonged out of hospital transport time, and delays in emergency care. Diversion is a courtesy request made by a hospital to the emergency communication center. Divert status should not be considered a method for a hospital to manage or mitigate excess volume / surge or ED holds. Significantly increased diversion requests with inconsistent expectations and understanding by all parties makes the current system of diversion ineffective and unsafe for the patients we serve.
R: Effective December 9, 2021 at 1800 hours, the Bucks County Radio Room will no longer accept diversion requests from hospitals or notify EMS providers or other first responders of the divert status. This moratorium on diversion is for any requests based upon excess patient volume / surge / ED holds (i.e.: general divert, crisis divert). A hospital may still notify the BCRR when they must close to certain emergent conditions (STEMI, Stroke, Trauma) or for a major infrastructure emergency (declared internal disaster). The EHS office will review the situation weekly to determine if the moratorium on diversion may be lifted.