Hospital Capacity and Emergency Department Diversion: Four Community Case Studies
April 2004
American Hospital Association
An American Hospital Association (AHA) survey on hospital capacity constraints and ambulance diversions finds inpatient occupancy rates captured at midnight fail to reflect volume fluctuations by day and time of day and illustrates the difficulty of anticipating and responding to changes in demand -- which according to the survey can be extreme. The case studies done by The Lewin Group follow up on a 2002 national survey by Lewin (Emergency Department Overload: A Growing Crisis) that found nearly 80% of urban hospital EDs are at or over capacity, with more than half reporting diversions. The latest survey looked in depth at 28 hospitals in four communities -- Louisville, KY; Portland, OR; Harrisburg, PA; and El Paso, TX -- to see when and where capacity constraints occur within the hospital and how diversion situations develop across a community.
The study found capacity constraints and ambulance diversions continue to be concerns in these communities, with more than half of the hospitals in each community reporting their EDs at or over capacity. Though all of the communities experienced some level of ambulance diversion, diversion hours varied by community, as did the factors driving the diversions and hospital capacity constraints. Even within a hospital, the specific capacity issue leading to diversion differed across the three days studied.