ED Diversions in the Spotlight

The agenda for next month's meeting of the Health Services Cost Review Commission is expected to include an item on emergency department (ED) diversions, the growth of which has sparked concern for HSCRC Executive Director Donna Kinzer.

 

Kinzer is not the only one taking notice of a recent spike in diversions (statewide yellow alert hours have been rising steadily, from 12,745 in 2013, to 20,974 in 2014, to 28,612 in 2015). The Maryland Institute for Emergency Medical Services Systems has also flagged the increase, and there's been some buzz about media inquiries. To date, MHA has not received any media calls on this issue, but we've prepared some talking points in case you are contacted.

 

There are likely many factors that contribute to this recent trend, from an uptick in seasonal flu cases (Maryland's Department of Health & Mental Hygiene has been consistently recording "widespread" influenza activity, with some weeks showing more than 1,100 ED visits for flu-like illnesses) to a growing shortage of qualified nurses (due to retirements and other reasons, hospitals are having trouble finding and retaining specialty nurses like those who work in EDs and other areas where ED patients might be sent for appropriate care. The U.S. Bureau of Labor Statistics projects a need for more than 1 million new RNs). An 18 percent jump over the past three years in behavioral health ED visits, for which patients remain in the ED longer, makes the issue even more challenging.

 

As MHA continues to discuss these concerns with the HSCRC and others, it's important to remember that diversions can help ensure patients receive timely care when an ED is overwhelmed. And, directing patients to the right care setting is a pillar of the All-Payer Model and of the Triple Aim. It's also important to watch more than one metric to understand the impact on care. Other measures, like ED wait times and leaving the ED without being seen, should be looked at in combination.

 

Hospitals take diversions seriously. Mitigation of this trend will require a deeper understanding of the issues and drivers and could take several different forms. We'll keep you apprised of the conversations as they continue to evolve and, as always, we'll make clear that hospitals are equal and eager partners in ensuring quality, speedy care for all in need.