Diversion of patients happening more often

Caldwell County patients in need of medical transport and who are seeking care at their physicians' home hospital increasingly are being sent to other facilities, according to the county's emergency management supervisor.

“What we are seeing with diversion is that it is causing a hardship for patients and our staff,” Caldwell County EMS Director Tommy Courtner said.

Diversion is a status that hospitals declare when their facilities become overloaded with patients. As a result, a patient en route by ambulance to an area hospital, could wind up at another care center.

According to the Center for Disease Control, the growth in emergency medical services has not coincided with an increase in hospital emergency departments. In a recent 10-year CDC study, emergency department visits increased by 18 percent to 110 million, but the number of hospitals operating 24-hour emergency departments decreased by 12 percent.

Courtner related a recent incident that involved a cancer patient who was caught up in a diversion declaration while being taken to Valdese Hospital, the operating location of the patient's family physician. Instead of going to another facility, the patient removed the intravenous lines while in the ambulance and received transport to the hospital by a spouse and was admitted.

“It's a reality check,” Courtner said. “To me, it's a hardship on us, and it's a hardship on the patient.”

Courtner said a sharp increase in the number of emergency calls, most likely related to the aging of the population, are contributing to the diversion declarations. In 2003, Caldwell County EMS staff responded to 7,545 calls. That total rose to 11,865 in 2007, and the department already has fielded 360 more calls in the first three months of 2008 than it did last year.

In fielding those calls, Courtner said patients prefer being transported to their family doctor, if possible. But with more transports being diverted, he said county ambulances are having to make longer, more time-consuming trips.

“We are running 60 calls per day with five ambulances,” Courtner said. “And the longer transports take one of my vehicles out of service.”

In order to prepare for potential problems, Courtner said his office receives a State Medical Asset Resource Tracker Tool (SMARTT) advisory each morning that details the status of each hospital for specialty services such as emergency care, orthopedics and surgery. The list is updated every eight hours.

Courtner said his department has a strong working relationship with Caldwell Memorial Hospital and has not encountered frequent problems with declared diversions.

“Caldwell Memorial does go on diversion sometimes,” he said. “We will try to take them somewhere else if it's not immediate care.”

Caldwell Memorial Vice President and Chief Nurse Executive Chuck Scronce said working through diversion declarations requires cooperation among the care centers.

“We talk to all the hospitals if there is a diversion status, or if there is the hint of a diversion status,” Scronce said. “The unspoken rule is if everybody is on diversion then nobody is on diversion.”

Scronce added that the hospital will not turn patients away, though it may request EMS staff to find alternatives for non-critical care patients when the facility is crowded.

“If there is a critical patient, (EMS personnel) are going to bring them here, regardless of what kind of status the hospital has,” Scronce said.

Scronce recalled a recent situation where Frye Regional Medical Center in Hickory was on diversion for two days. He said in those instances, he and other staff managers will assist in the care center.

“We can't create more beds, there are too many hoops to jump through,” Scronce said. “Moreso, in the last six months we added into our vascular service and a pulmonologist for inpatient and outpatient. We've opened up beds that we haven't used in some time. We'll put (patients) anywhere we can as long as we have resources.”

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