Abstract

Background: Ambulance diversion (AD) occurs when emergency departments (EDs) experience over-demand of available resources and can no longer accept ambulance patients. Current evidence however, shows that AD delays critical care, negatively impacting quality and cost. The purpose of this project was to reduce AD by creating an evidence-based protocol in the ED setting. Methods: Underpinned by Kurt Lewin's Change Theory and following a Plan Do Check Act model, a healthcare quality improvement team implemented an AD protocol in a busy urban ED. Baseline data was taken from historical hours of AD use and ambulance arrivals over the previous three years. Following a pre-test—post-test design, three year baseline data was compared to data from a 20 week trial using the paired samples t-test. Intervention: An AD protocol was created in the project setting. The protocol used the National Emergency Department Overcrowding Scale tool, with corresponding overcrowding response strategies to make AD decisions. Results: The mean hours of AD fell from 13.10 hours per week to 2.23 hours per week. The mean number of ambulance patients rose from 156 patients per week to 185 patients per week. Conclusion: Measuring ED overcrowding and using the AD protocol, the healthcare quality improvement team successfully reduced AD in their project setting. Additionally, an improved understanding between ED overcrowding and AD emerged. This enhanced understanding may present opportunity for similar projects in other EDs seeking to reduce AD as well.

Author Details

Kathryn S. Rogers DNP, RN, NEA-BC, CEN, CPEN, TCRN, CPHQ

Sigma Membership

Non-member

Lead Author Affiliation

Northern Arizona University, Flagstaff, Arizona, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Quality Improvement

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Ambulance Diversions, Emergency Department, ED, Diversion, Divert

Advisor

Watkins, Katherine

Degree

DNP

Degree Grantor

Northern Arizona University

Degree Year

2019

Rights Holder

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Review Type

Faculty Approved: Degree-based Submission

Acquisition

Self-submission

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