CLEVELAND, Dec. 2 /PRNewswire/ -- Ambulance diversion is an astonishingly common problem in Greater Cleveland and throughout the nation, but three hospitals on the West Side are working feverishly to resolve the problem for the benefit of our community. “Diversion” takes place when hospitals report that they are too busy to take on new patients and tell ambulances to go to another hospital.
Beginning October 1, Fairview, Lakewood and Lutheran Hospitals, all members of the Cleveland Clinic Health System - Western Region, instituted a “No Diversion” Policy. So far, eight weeks into the policy, all three hospitals have achieved this goal. “The purpose of this aggressive goal is to assure our hospitals are open to the patients and physicians that we serve,” says Fred DeGrandis, chief executive officer of the Cleveland Clinic Health System - Western Region. “It also advances our partnership with local EMS as it allows squads to remain closer to community residents so that emergency ambulance response is not delayed.”
Since January 1, Fairview, Lakewood and Lutheran Hospitals have taken steps to significantly reduce diversion hours over 2003, with a goal of “zero diversion” by October 1. As of the end of October, Lutheran Hospital had recorded zero ER diversion for six of the last seven months; and Fairview Hospital had recorded its third consecutive month of no hours of diversion. In total, for the first 10 months of the year, ER diversions for Fairview, Lakewood and Lutheran Hospitals were reduced by more than 66 percent over the previous year, from 1,497 hours to 648 hours. Countywide, ER diversion hours are down only about 14.4 percent, from 16,748 hours for the first 10 months of 2003 to 14,331 hours when compared to the same time period this year.
“We appreciate the hard work and leadership demonstrated by everyone at Fairview, Lakewood and Lutheran,” says Edward J. Eckart, Jr., commissioner of the City of Cleveland’s Division of Emergency Medical Service. “I can attest that their commitment to maintaining an ‘open’ emergency department will result in better care for our patients”
In addition to speedier access to an ambulance and a local hospital, zero diversion results in other patient benefits, too. “It is important for patients to go to their regular hospital, that’s where their medical records are stored and that’s where their doctors practice,” says Neal Chadwick, M.D., vice president of medical affairs for Fairview, Lakewood and Lutheran Hospitals.
“Emergency departments provide an essential community service,” says Matthew Lashutka, M.D., a physician in the Lakewood Hospital Emergency Department and co-medical director of WESHARE (West Shore Area Rescue Association). “Unfortunately, it is often easier for hospitals to respond to increased patient activity by diverting patients to another hospital. However, it is essential that patient care not be delayed, especially at a time when we have added responsibilities to be prepared to respond to disasters or acts of terrorism.”
According to Mr. Eckart of the city’s Division of EMS, the continuing diversion policies of other Greater Cleveland hospitals make the “no- diversion” goals even more difficult to achieve, as many of their patients are diverted to the emergency rooms of Fairview, Lakewood and Lutheran. “A zero- diversion policy is a very difficult task,” he says. “Fairview, Lakewood and Lutheran Hospitals have been successful due to the focus and commitment at all levels of the organization. We are hopeful that all hospitals will entertain the same operational assessment and review of their facilities and work with us in attaining zero diversion,” he says, noting that diversion often puts his paramedics in a tough spot - between a scared patient and family and an overworked ER staff.
The reason diversion has become so commonplace among hospitals is complex. For more than a decade, hospitals have been squeezed by lower reimbursements and growing competition, and have responded by downsizing, closing beds and, in some circumstances, closing. For example, the closing of Mount Sinai, St. Luke’s, Deaconess and St. Michael hospitals has placed significant strains on hospital emergency rooms throughout Greater Cleveland. And technological advances have created more treatment options and an aging population that is bringing sicker, older patients to the hospitals. And it’s more than an emergency room problem. Often times it is necessary to free up hospital beds to facilitate the transfer of patients from the emergency room into the hospital.
“Diversion was intended to mitigate the shortage of beds and to mobilize staff to critical care areas, but it has turned into a long-term management tool for hospitals,” says DeGrandis. “It is a significant challenge, but for the good of the community, we had to take a hard look to see how our hospitals could respond to the problem.”
With a goal of zero diversion, groups of physicians, nurses, allied health professionals and employees at Fairview, Lakewood and Lutheran began meeting to see how the hospitals could improve efficiencies, increase capacities, increase the flow of patients from emergency room into hospitals beds, develop response teams and set up protocols to work toward reducing diversion hours. Many of their ideas and “best practice” protocols were shared between the hospitals.
“It is obvious that their vision has become the guiding force for all of their employees,” says Eckart, commissioner of the area’s largest EMS provider. “We appreciate their efforts and we look forward to working cooperatively in making this a success.”
Fairview Hospital; Lakewood Hospital; Lutheran Hospital
CONTACT: Gary Weiland of Cleveland Clinic Health System - WesternRegion, +1-216-476-4242