Emergency Department Overcrowding/Ambulance Diversions

Since 1988 the number of emergency rooms in the United States has declined by 1,235. (Source: American College of Emergency Physicians)

The number of emergency departments (EDs) is down from levels in the 1980s, while the number of ED visits is rising. As a result, many communities are experiencing frequent diversions of ambulances when EDs cannot see more cases and hospital beds are full.

HRET is conducting a research project to collect and analyze data on the prevalence and causes of ED overcrowding and ambulance diversions.

Funding: The Robert Wood Johnson Foundation

Partners: American College of Emergency Physicians, American Organization of Nurse Executives
The study will be based on two surveys: one of ED administrators, nursing directors, and medical directors in a random sample of 600 general hospitals; the other, of emergency medical services agencies in each of the nation's 20 largest metropolitan areas.

The first survey will collect data on the prevalence of ED overcrowding and ambulance diversions, the perceived causes of overcrowding, and the ways that hospitals are responding to excess demand for emergency services. The second survey will collect data on the different dates of ambulance diversion and the number of hours of diversion for each hospital over the course of one month.

Three sets of questions are especially relevant for the development of future policy on these issues:

  1. What is the current incidence of ED overcrowding and ambulance diversion and how has it changed in recent years? In which hospitals and in which communities are ED overcrowding and ambulance diversions most prevalent?
  2. Why and when do EDs in large metropolitan areas go on diversion?
  3. How are hospitals responding to increased demand for ED services?

The results of this study are important for policymakers and planners to reassess the level of staffing and funding available for community access to emergency services.