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Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004.
Ann Emerg Med. 2006 Apr; 47(4):309-16.AE

Abstract

STUDY OBJECTIVE

We assess the effects of nearby hospital closures and other hospital characteristics on emergency department (ED) ambulance diversion.

METHODS

The study design was a retrospective, multiple interrupted time series with control group. We studied all ambulance-receiving hospitals with EDs in Los Angeles County from 1998 to 2004. The main outcome measure was monthly ambulance diversion hours because of ED saturation.

RESULTS

Our sample included 80 hospitals, of which 9 closed during the study period. There were increasing monthly diversion hours over time, from an average of 57 hours (95% confidence interval [CI] 51 to 63 hours) in 1998 to 190 hours (95% CI 180 to 200 hours) in 2004. In multivariate modeling, hospital closure increased ambulance monthly diversion hours by an average of 56 hours (95% CI 28 to 84 hours) for 4 months at the nearest ED. County-operated hospitals had 150 hours (95% CI 90 to 200 hours) and trauma centers had 48 hours (95% CI 9 to 87 hours) more diversion than other hospitals. Diversion hours for a given facility were positively correlated with diversion hours of the nearest ED (0.3; 95% CI 0.28 to 0.32). There was a significant and positive interaction between diversion hours of the nearest ED and time, suggesting that the effects of an adjacent facility's diversion hours increased during the study period.

CONCLUSION

Hospital closure was associated with a significant but transient increase in ambulance diversion for the nearest ED. The temporal trend toward more diversion hours, as well as increasing effects of the nearest facility's diversion hours over time, implies that the capacity to absorb future hospital closures is declining.

Authors+Show Affiliations

Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, CA, USA. bsun@post.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16546614

Citation

Sun, Benjamin C., et al. "Effects of Hospital Closures and Hospital Characteristics On Emergency Department Ambulance Diversion, Los Angeles County, 1998 to 2004." Annals of Emergency Medicine, vol. 47, no. 4, 2006, pp. 309-16.
Sun BC, Mohanty SA, Weiss R, et al. Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004. Ann Emerg Med. 2006;47(4):309-16.
Sun, B. C., Mohanty, S. A., Weiss, R., Tadeo, R., Hasbrouck, M., Koenig, W., Meyer, C., & Asch, S. (2006). Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004. Annals of Emergency Medicine, 47(4), 309-16.
Sun BC, et al. Effects of Hospital Closures and Hospital Characteristics On Emergency Department Ambulance Diversion, Los Angeles County, 1998 to 2004. Ann Emerg Med. 2006;47(4):309-16. PubMed PMID: 16546614.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004. AU - Sun,Benjamin C, AU - Mohanty,Sarita A, AU - Weiss,Robert, AU - Tadeo,Richard, AU - Hasbrouck,Maureen, AU - Koenig,William, AU - Meyer,Carol, AU - Asch,Steven, Y1 - 2006/02/03/ PY - 2005/07/27/received PY - 2005/11/17/revised PY - 2005/12/01/accepted PY - 2006/3/21/pubmed PY - 2006/4/1/medline PY - 2006/3/21/entrez SP - 309 EP - 16 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 47 IS - 4 N2 - STUDY OBJECTIVE: We assess the effects of nearby hospital closures and other hospital characteristics on emergency department (ED) ambulance diversion. METHODS: The study design was a retrospective, multiple interrupted time series with control group. We studied all ambulance-receiving hospitals with EDs in Los Angeles County from 1998 to 2004. The main outcome measure was monthly ambulance diversion hours because of ED saturation. RESULTS: Our sample included 80 hospitals, of which 9 closed during the study period. There were increasing monthly diversion hours over time, from an average of 57 hours (95% confidence interval [CI] 51 to 63 hours) in 1998 to 190 hours (95% CI 180 to 200 hours) in 2004. In multivariate modeling, hospital closure increased ambulance monthly diversion hours by an average of 56 hours (95% CI 28 to 84 hours) for 4 months at the nearest ED. County-operated hospitals had 150 hours (95% CI 90 to 200 hours) and trauma centers had 48 hours (95% CI 9 to 87 hours) more diversion than other hospitals. Diversion hours for a given facility were positively correlated with diversion hours of the nearest ED (0.3; 95% CI 0.28 to 0.32). There was a significant and positive interaction between diversion hours of the nearest ED and time, suggesting that the effects of an adjacent facility's diversion hours increased during the study period. CONCLUSION: Hospital closure was associated with a significant but transient increase in ambulance diversion for the nearest ED. The temporal trend toward more diversion hours, as well as increasing effects of the nearest facility's diversion hours over time, implies that the capacity to absorb future hospital closures is declining. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/16546614/Effects_of_hospital_closures_and_hospital_characteristics_on_emergency_department_ambulance_diversion_Los_Angeles_County_1998_to_2004_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(05)01991-8 DB - PRIME DP - Unbound Medicine ER -