By Carrie Mortrud, RN
You see it on TV all the time. A person (ok, an actor) is hurt or sick and needs emergent transportation to the hospital. Medics put him or her into the ambulance, flips on the lights and siren; and they’re off in a flurry. The ambulance speeds to a nearby hospital where a nurse pushes the patient through those doors when it makes the crash sound, and a team of health care experts are waiting their arrival.
You never see what happens in between. When the medic calls the hospital and lets somebody know they’re coming, who says “sorry, we’re full.” You never see a patient get diverted or a unit get closed to admissions, yet, it happens. It happens in Minnesota, and, if you read this article, it happens in Cleveland, which also has some pretty good hospitals.
This article says how it happens but not why. It outlines the policies and procedures that guide the decision and lists all the other options that must be exhausted before a hospital “goes on divert.” It explains that says patients are diverted and their care is delayed because there’s not enough “space” at a facility. SPACE! Really? We’re talking about patients here, not old furniture. You don’t need space or beds to care for patients. You need people. You need (we all need) the appropriately trained people to care for patients, especially those in need of urgent or emergent care. Hospitals should only divert patients away potentially delaying their care only when there is not enough staff or the right staff on duty at the time to take care of them. Accepting urgent and emergent patients simply because there is SPACE for them is not ethical in my opinion. I would rather risk riding around in the back of a rig with 1:1 or sometimes 2:1 staffing than be brought to an emergency room that had an empty bed and room but no staff.
Yes it’s true no one can predict when an emergency might come in, but every hospital should plan for emergencies and have cross-trained nurses and staff to float when necessary. This article names a few hospitals that have ended diversion practices altogether. With the appropriately trained and right number of staff, this practice could and should be the standard, not the exception.