According to a study published in the August Issue of Health Affairs, hospitals are more likely to divert ambulances, be over populated and delay timely emergency care if they are located in areas with large minority populations.

In order to determine if overcrowding in emergency rooms disproportionately impacts racial and ethnic minorities the team analyzed ambulance diversion in more than 200 hospitals across the United States. The team discovered that compared with non-minorities, minorities are more likely to be affected by emergency crowding.

Renee Y. Hsia, MD, assistant professor of emergency medicine at UCSF, and an attending physician in the emergency department at San Francisco General Hospital & Trauma Center, explained:

“Our findings show a fundamental mismatch in supply and demand of emergency services. If you pass by a closer hospital that is on diversion for a hospital 15 minutes down the road, you are increasing the amount of time the patient is in a compromised situation. It puts these patients at higher risk for bad health outcomes from conditions like heart attacks or stroke, where minutes could mean the difference between life and death.”

When a hospital’s ER is too overcrowded to accept new patients, ambulances are diverted to the next available ER, sometimes miles away. The demand for emergency care has increased in recent years and is particularly common in urban areas.

For the study, the team examined ER’s at all of California’s acute, nonfederal hospitals operating in 2007. They did not examine pediatric hospitals as they usually do not treat adults. In addition, they did not examined hospitals in counties that forbid the practice of ambulance diversion.

In total the researchers examined 202 hospitals in 20 counties. Overall, 92% of the hospitals were on diversion for a median of 374 hours over a one year period. According to the researchers, hospitals who handled the highest numbers of minorities were on ambulance diversion for 306 hours vs. 75 hours at hospitals with less minority patients.

The researchers explained: “Because ambulances typically transport patients needing true emergency care, diversion reroutes the neediest patients away from their nearest hospital, representing a failure of the systems to provide the intended care.”

Limitations of the study included:

  • The study only looked at hospitals in California
  • Diversion is an imperfect measure of overcrowding – even when an ER is on diversion status, some patients, especially trauma patients, can still be accepted.

Hsia concluded:

“Emergency departments and trauma centers are closing more frequently in areas with vulnerable populations, including racial and ethnic minorities. This is a systems-level health disparities issue that requires changing the ‘upstream’ determinants of access to emergency care. It’s not just a problem at the level of the emergency department itself, but of the hospital and entire system.”

The study findings highlight the need for systemic reform, including statewide criteria regulating diversion polices and better management of hospital flow.

Written by Grace Rattue