More on Quality and Safety

Certain hospitals turn away ambulances when the patient is more likely to be poor, study shows

Private hospitals are more likely to enact an ambulance diversion if a nearby public hospital is already turning away ambulances.

Jeff Lagasse, Associate Editor

Occasionally a hospital will close itself off to ambulances, and the facilities that do so usually claim it's due to volume issues. A new study, however, suggests that may not always be the case.

Looking specifically at California, Health Services Research uncovered evidence that hospitals turning away ambulances may be doing so for financial reasons; the story was originally reported in the Milwaukee Journal Sentinel. While some hospitals argue that they want to avoid scenarios in which sick patients are spending eternities waiting in the emergency room, data shows the likelihood of patients being poor may be closer to the truth.

Private hospitals, the study found, are more likely to enact an "ambulance diversion" if a nearby public hospital is already turning away ambulances. Public hospitals typically treat lower-income patients.

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The researchers called this "strategic diversion."


Private hospitals' ambulance diversion decisions were strongly linked to whether the nearby hospital turning away ambulances was public or private.

The private hospitals were more likely to shut themselves off if the nearby hospital was public, which is one of the data points suggesting they're avoiding accepting Medicaid and uninsured patients. These decisions, the study found, can sometimes cause critical delays for vulnerable populations, and could increase the likelihood of an adverse event, even death.

While the practice naturally affects poor patients in particular, it can negatively impact anyone who's in an ambulance at the time of the diversions.

Evidence suggests that, despite the dip in patient volumes, some hospitals actually make more money during ambulance diversions because the profits are higher on such procedures as planned surgeries -- and surgeries may be cancelled when there are too few beds due to high ER volumes.

Once the public hospitals reopen to ambulances, the private hospitals are more likely to come off diversion, the findings showed. The authors claim it as evidence that the latter wanted to be open for patients once there was a lower likelihood of accepting poorer patients.


Temporary diversions of ambulances from the nearest hospital can harm patients with life-threatening conditions, including heart attacks and stroke, according to a 2015 Health Affairs study.

Some hospitals see diversion as a necessary safety valve for full emergency rooms, but emergency care experts say they push the crowding problem to nearby hospitals and can compromise patient care, especially in life-threatening cases.

Twitter: @JELagasse

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