I'm John Diedrich, an investigative reporter at the Milwaukee Journal Sentinel. I have been a reporter for almost 30 years. Recently, I've been looking into what happens when hospitals close to ambulances, something called "diversion." I had not heard of this until I found a case in Milwaukee of a woman who had a stroke close to the top hospital for stroke care in our county -- she was turned away and sent to a hospital three miles away and then another five miles from there. That got me looking in diversion, why it happens, what are the risks and how some places including Boston have figured out a better system. I learned about the case of a critically ill baby who was turned away from a top children's hospital in Chicago 30 years ago and how the system in Illinois today is still failing to hold hospitals accountable. For this investigation, I traveled to Chicago three times, went to Boston to see where diversion was banned 10 years ago and went to Dallas to attend a meeting of top EMS leaders to learn about the issues they face including diversion. I began amassing a pile of paperwork, studies, news articles and records that now has filled a dozen three-ring binders and is growing along with

I'm Kevin Crowe, a data journalist with USA TODAY and formerly the Milwaukee Journal Sentinel. I'm the one who focuses on columns and rows in investigations. I've spent much of the past year hunting for and analyzing ambulance diversion data from cities and states across the country. At this point, I think I know the tidyverse better than my own children.

Proof: https://i.redd.it/fcx7uzug16x31.png

Edit: That's all the time we have right now, but we'll pop back in later and try to answer some straggler questions.

Comments: 826 • Responses: 12  • Date: 

Guns_57371 karma

Don't medic crews call into these hospitals en route to inform them of the incoming patient (AFAIK standard practice)? If yes, why would the hospital not make it clear that they will not accept the patient?

journalsentinel44 karma

Yes, EMTs do work through the local EMS systems. That's where they learn about which hospitals are on diversion and which aren't. In Chicago, the regional hub would let the medics know which hospitals are open to ambulances. An important thing to note is that some hospitals will accept serious trauma cases like shooting victims even when they're on diversion.

meatballlady360 karma

How often is it the case that diversion is necessary/actually saves a life? My first thought was that if they are out of resources at the exact moment such that it would take 30 min before they could get to them, and there's another hospital 10 min away that could see them immediately, wouldn't that be a good thing?

journalsentinel73 karma

The theory behind ambulance diversion is that it is supposed to direct ambulances away from jammed ERs to less-busy hospitals that can offer care more quickly. In practice, that is often not how it works because when one hospital goes on diversion, surrounding hospitals typically are soon overwhelmed by the diverted patients.

There also is an assumption in this scenario, that the only two options are to go to an overcrowded ER and wait for care or go to a more distant (and perhaps less-qualified) hospital and get care there. In the places where diversion has been ended, it has been shown there is another option that gets at solving the issue of ER crowding. That is to reform the rest of the hospital options so the ER can be more quickly emptied. For instance, hospitals are adjusting elective surgery schedules, reforming admissions and discharges and changing how rooms are cleaned, all with an eye to making the movement of patients more efficient.

To the question: How often is it the case that diversions save lives? No one knows that because there have been no peer-reviewed studies of ambulance diversion systems. There have been several studies that indicate diversion does not solve overcrowding and poses risk to patients.

dazedwit-1 karma

Have you found any racial or class bias related to diversions?

journalsentinel-8 karma

Yes, researchers have found that hospitals serving large minority populations typically go on diversion more often than other hospitals. Here's a link to one of those studies: https://www.healthaffairs.org/doi/10.1377/hlthaff.2011.1020 Another study found that ambulance diversion had a higher impact on black heart attack patients than white patients: https://www.ncbi.nlm.nih.gov/pubmed/28583966 In general, researchers have found that people who take ambulances are on the whole older, poorer and sicker: https://www.jsonline.com/story/news/investigations/reports/2019/10/25/ambulance-diversion-hospital-closure-policies-more-likely-affect-sicker-poorer-patients/4066061002/