Communication of a diversion message
February 1, 2001 3 minutes read
Communication of a diversion message
When communicating your diversion message, the following questions must be answered, according to James J. Augustine, MD, FACEP, CEO of Premier Health Care Services, a Dayton, OH-based physician management group that provides ED staffing and consulting.
Why is the diversion occurring? It could be due to:
- safety reasons;
- ED compromised;
- certain hospital services unavailable;
- CT scan;
- monitored beds;
- critical care beds;
- dialysis, etc.;
- labor and delivery;
- a "nearby" hospital not compromised in its ability to deliver care.
Who is diverted? This list might include:
- all patients;
- care can take place temporarily in "parking lot" with rendezvous with on-site transport vehicles;
- no care can occur. Facility and ED staff fully compromised;
- message must go out by EMS channels plus to the general public through the media;
- EMS patients;
- all EMS patients;
- patients who have an identified need that EMS personnel can recognize;
- all monitored patients;
- all trauma patients;
- all critical care patients
- all patients who may require CT scan (strokes, head injury);
- all patients utilizing a special hospital service, such as dialysis and labor and delivery, which is compromised.
How large a population and EMS system will be affected?
- Diversions from a regional referral center, such as the children’s hospital, the trauma center, or the burn center, will need to be communicated widely.
- A hospital isolated in a large geographic area will be more difficult to divert.
What are the legal implications?
- Care compromise is not as defensible if uncompromised care is available for a patient within a reasonable transport time.
- Diversion policy must be developed and applied consistently and not subject to real or perceived financial motivation.
- Diversion, rendezvous, and transfer incidents each have EMTALA implications. Documentation should support medical judgment, clear communications, consistency, and lack of financial motivation.
How long will diversion last? It could last:
- a foreseeable and predictable time frame that is short (hours);
- an unknown but short time frame (hours);
- an unknown and lengthy time frame (structural collapse from an earthquake).
How will message be communicated and to whom? Communication could include:
- other surrounding EDs (by phone, fax, radio, or electronic interchange);
- local EMS;
- regional EMS;
- general public media;
- physician offices.
Is the ED physician medical control able to override the diversion decision? Options include:
- no, as in situations in which the ED is unsafe;
- yes, when the ED physician can assist in patient care in locations such as the parking lot;
- yes, when the ED can accommodate the patient, then arrange transport to another hospital;
- yes, when the ED physician can arrange a rendezvous with a skilled transport vehicle (helicopter or mobile intensive care unit);
- yes, when the patient will be evaluated in the ED and then further disposition decisions are made.
Is there a specific site to divert to? Options include:
- yes, (all children under the age of 14 are being diverted to ______ hospital);
- no, but call us and we may be able to help make decisions with you;
- no, and we cannot help make decisions (phones, radio and/or staff are unavailable).
Is rendezvous in the parking lot an option?
- The ED and/or hospital is compromised, but the parking lot available to transfer patients to another hospital with a higher level of care.
- A vehicle is placed in the parking lot with appropriate staff to perform rendezvous.
- ED staff available in the parking lot to assist in evaluation, urgent treatment, and the destination decision.
- EMTALA implications are addressed by good documentation.
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