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What is the role of federal government in this issue?
How can we incentivize hospitals to prioritize ED capacity?
What do diversion times look like across the country accounting for race and socioeconomic background?
-What are some strategies or technologies that can be implemented to increase communication between ED’s, dispatch, and EMT drivers?
-Neha

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1. Increase accurate communication between EMT drivers and dispatch to always have updated information on beds open in each ED.
2. Increase federal regulations regarding diversions for accountability and maximum diversion waiting times to make sure no one is diverted too long to affect health outcomes. Data would have to be compiled to determine what that time marker would be.
3. Incentivize ED beds or care to avoid diversions. This could be by making the hospital overall more efficient or increasing ED capacity.
-Neha

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In an attempt to mitigate overcrowding of emergency departments, hospitals have begun diverting ambulances which has inadvertently negatively affected patient health outcomes.-Neha

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Lisa E.

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How can we enlist EMS. ER and hospital staff, innovative thinkers and other stakeholders to brainstorm ways to reduce system inefficiencies?

How can local, state and federal government assist with solving these issues?

Is there a way to divert patients with less serious needs and treat them more efficiently in another setting while freeing up space for more complex cases?

- Lisa E

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1.    Create a committee/agency under Health and Human Services to track ambulance diversion and attendant health outcomes nationwide. Develop some sort of accountability policy for diversion, i.e. fines, compliance plan to reduce hospital inefficiencies and reporting requirements, like a government issued consent order where they must fix the problems before the government agrees to lift it.
2. Draft legislation which requires hospitals that deliver advanced comprehensive care to accept all patients presenting with that condition. Give EMS workers the autonomy to override diversion when critical based on their professional judgment.
3. Require (and subsidize) certain urgent care locations in urban areas and areas with chronic hospital overcrowding to accept uninsured and underinsured patients with less serious medical issues in order to free up ERs for more critical care.   - Lisa E.

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While hospitals have attempted to reduce their own emergency department overcrowding by diverting incoming ambulances to neighboring hospitals, diversion creates a host of new problems for all area hospitals, resulting in delayed patient care and disparate health outcomes, without actually resolving the original problem.           - Lisa E.

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1. Are there specific patient conditions or problems that seem to be causing backlog?

2. Are there pressures to divert patients, especially from insurance companies, upper level management, government regulations, etc.?

3. How is the decision to divert made? When making this decision, are the possible consequences considered?

- Nathalie B

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- Nathalie B

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1. Gather data on ER staffing ratios in a particular area - is the ER regularly fully staffed? Is there any connection between staffing shortages and the likelihood of diversion?

2. Run a pilot program, designed to improve ER efficiency, at a smaller emergency department. Assess what the impacts of this program are, how expensive it is, how long it takes to implement, and whether it is possible for larger emergency departments to implement it in a similar manner.

3. Seek information on motivations for diversion - if there are several motivating factors, what are they, and which ones get the most weight?

- Nathalie B

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- Could this solution impact minority groups in an unfair way? 

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- Could this solution impact minority groups in an unfair way? 

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- What do the workers in the ER think about this possible solution?
- Does this solution have the best interest for all of our patients?

-Tyler

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-Tyler

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Ambulance diversions can affect anyone who needs an ambulance to get to an emergency department. Hospitals typically divert ambulances when their emergency rooms are experiencing a high volume of patients. However, turning ambulances away is not the best solution to this issue and the practice can result in not only poor patient outcomes, but disparate ones as well.
- Nathalie B

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1.) Put a federal policy/legislation in place that restricts the amount of times/scenarios that hospitals can divert ambulances. 

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1.) Put a federal policy/legislation in place that restricts the amount of times/scenarios that hospitals can divert ambulances. 

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2.) Conduct national study on amount of time hospitals are on "ambulance diverting" and the amount of extra time those diverted ambulances took to get the patient to care, and outcomes.
-Tyler

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An attempt to decrease hospital overcrowding has resulted in the dangerous practice of ambulance diversion, which has proven ineffective against overcrowding.           -Tyler 

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An attempt to decrease hospital overcrowding has resulted in the dangerous practice of ambulance diversion, which has proven ineffective against overcrowding.           -Tyler 

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Krissy A.

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1. Why isn't the federal government stepping in more to address this issue?
2. What would nurses and ED staff say about the types of measures they believe could help overcrowding?
3. Do insurance companies benefit from divergence programs? - Krissy A.

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1) Educate EMTs on their legal rights to deliver patients to hospitals regardless of diversion status and work with employers to ensure EMTs are not being punished for exercising within their legal rights.
2) Create a better communication system between 911 call centers, emergency medical services, and health care facilities and improve efficiency of transporting patients from the site of illness or injury to a health care facility. - Krissy A.

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Hospitals are diverging ambulances from bringing patients to the ED in an attempt to relieve overcrowding. However, their efforts are misplaced because diverging ambulances has not proved to alleviate busy EDs and has instead endangered patient lives.  - Krissy A.