By Christina Orlovsky, senior staff writer

With emergency departments filling fast and staffing shortages commonplace, hospitals across the country are often forced to divert emergent patients to facilities that aren’t filled to capacity, placing the patients in danger and putting unwanted stress on pre-hospital care providers. One county in Washington State has decided to put an end to diversions, implementing a policy whereby all hospitals will accept critical patients, even if they’re already short on beds.

Prompted by anecdotal evidence from emergency medical personnel who reported that they were having difficulty finding emergency departments to accept patients, the Central Region Emergency Medical Services and Trauma Care Council in King County, Washington, created a new ED Saturation Policy prohibiting the use of the word “divert” when critical patients are in need.

“Our pre-hospital providers were having to drive far distances to find hospitals, and we had some hospitals that had significant times on divert,” explained Chris Martin, RN, BSN, director of emergency services at Harborview Medical Center, in Seattle—located in King County—and the chair of the Central Region Trauma Care Council. “We wanted to make sure we were giving the citizens the care they needed quickly, so we agreed that we would not use the word ‘divert,’ but rather use ‘treat and transfer’ and ‘ED saturation,’ meaning that critical patients can still come to those hospitals.”

The new policy charts hospital ED capacity status in green, yellow and red. Green is open with no restrictions; yellow is treat and transfer, meaning that the hospital is able to receive all patients, but that critical-care patients would be treated and then transferred to the closest hospital with critical-care capacity; and red is ED saturated, meaning the hospital has reached capacity to receive patients. A hospital can only be on ED saturated status for two hours at a time and no more than six hours in a 24-hour period.

Implementing the policy, Martin added, meant that all hospitals in the region had to work internally on their processes to ensure that they were always ready to accept more patients.

“It was a mind change,” she said.

“Before, when hospitals were on divert, they may have become more relaxed,” she added. “Now that the hospitals know they have to be able to discharge patients efficiently, effectively and expeditiously, emergency departments have had to come up with a plan to keep a bed open or at least have one quickly available. The hospital owns the patient more once they hit the ED door more than they used to, and they’re thrilled about it.”

In order to improve their processes, hospitals in the region have had to look closely at their staffing situations, because, as Martin explained, in many cases hospitals are not filled to capacity with patients, rather they’re functioning short staffed.

“In a tight situation you need to add staff, whether it’s through the use of travelers or just by adjusting the matrix,” she said. “Although the hospitals will tell you that it hasn’t necessarily been easy, they have all been able to do it.”

As hospitals nationwide face a growing crisis of more patients using the emergency department for primary care, Martin expects that more regions will begin to implement policies similar to that in King County. She intends to present the region’s model to the University HealthSystem Consortium to demonstrate the importance of collaboration on a regional level to improve the delivery and capability of the health care system.

“There are a lot of hospitals that have divert hours that are worse than ours, but in order for this to work, you have to have a city or county where all the hospitals can agree to implement the policy,” she said. “This will make a big difference for a while, but if we don’t have some major changes to our broken health care system, there is going to come a point in time when we really are at the breaking point.”

For more information, visit the Web site of the Central Region EMS and Trauma Care Council.

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