CardioExchange Archive

MI patients who are diverted to other emergency departments (EDs) while their local EDs are closed have an increased risk for death, according to a new study published in JAMA. Yu-Chu Shen and Renee Hsia analyzed data on all Medicare patients with MI from four California counties who were admitted to the hospital between 2000 and 2005.

At 1 year, the rates of death were:

• nearest ED not on diversion: 29%
• nearest ED <6 hours on diversion on the date of admission: 31%
• nearest ED 6 to < 12 hours on diversion on the date of admission: 30%
• nearest ED 12 or more hours on diversion on the date of admission: 35%

The investigators found several differences of potential importance among the hospitals. For example, the hospitals that received the diverted patients were less likely to have a catheterization laboratory and were more likely to be either a for-profit hospital or a government hospital.

In their conclusion, the authors point out that “diversion is a signal of a larger access problem in the health care system, representing resource constraints that are beyond patient factors and related to the hospital and health care system.” Their results, they write, “suggest that more integrated health care policies from the prehospital to in-hospital setting should include provisions that minimize instances in which hospitals are on diversion for prolonged periods.”