Recent Diversion Developments

[Guest alsfirefighter]

Tis the season. The flu outbreak has finally arrived as many of us in the field already know. And when it rains, it pours. At the time I write this, there are 8 hospitals in the county on diversion:

Hudson Valley

Phelps

United

White Plains

St. John's

Lawrence

Northern Westchester

Mt. Vernon

What is becoming increasingly apparant. Is that the region needs to immediately become involved and meet with the all hospital administrations and work on a diversion plan. Being that if mulitple hospitals are on diversion, all in a general area, that they will have to take patients regardless of status. In a prior system I was involved with in Virginia when the 3 available hospitals all went on diversion, each hospital got 1 patient on a rotating basis until they got off diversion. This was to try to space out the influx of ambulance personnel. We also need to step up and educate people what diversion means and emphasize the need of non emergent patients withhold needing transport. We all need to step up as professionals and deal with this issue before it gets worse and also effects our relationship with ED staffs.

Also I want to stress that diversion is not an abnormal event and we must deal with it. There are agencies whom like to say they don't care, or its not their problem. However it is your patients problem whom may not get the definitive care they need because of ED crowding. They are the reason why you don't go there.

[x648eng119 2]

Before we know it, NREMS will be transporting to PUTNAM!!!

They just put 30B1 into service in case Soundshore goes on diversion. See what this United Hospital epidemic is doing!

](*,) ](*,) ](*,) ](*,)

[Oswegowind 17]

diversion is a courtesy...screw them and go where the patient wants...it is their right...

[x648eng119 2]

diversion is a courtesy...screw them and go where the patient wants...it is their right...

Thats what they have been doing!!!!

Update as of 0339hrs on 1/4...

Hudson Valley and Northern West off diversion.

Remaining on Diversion:

Phelps

White Plains

Mt. Vernon

Lawrence

St. Johns

United....Duh

[x648eng119 2]

As of 0530hrs on 1/4

Phelps and Mt. Vernon are off diversion

[mikeinet 37]

The diversion thing may be a "courtsey" but its up for a REASON!!

It means they are overflowing with patients and cannot give adequate and full care to a new patient brought in...

If you have a pt with an injury and the hospital they're going to is on diversion... that means they're too busy to deal with what they already have, and bringing more is just going to lower the level of care, even if it's a request.

don't get me wrong, always follow a pt's requests, but a statment like Oswegowind is out of line a bit. The hospitals are doing YOU a favor by warning you they are too busy.

[Pudge3311 5]

I have found that in the not so recent past that hospitals use diversion when they are understaffed. I have been to two hospitals in the area, both at night with four or five open beds in the ER, and they asked why the patient was brought in because they were on diversion. When asked why they were on diversion seeing as they had plenty of open beds, they said we are the only ones here, meaning the doc, and two or three nurses. IMO, the diversion status is being abused by the hospitals, and when EMS sees this they stop honoring the diversion status.

[Pyroinvestigator 0]

Hospitals use diversion when they don't have any beds upstairs for patients to go to or they are understaffed on the floors......so the ER might be empty..and many times that I have arrived...the were just that, EMPTY..so the patient would get the whole ER and it's staff to themself...so it is NOT always true that the patient would not be given immediate care...and if you do bring in a pt. that needs immediate care...that is what triage is for....if you have someone who needs care...and 8 of the area hosp. are on diversion...then what do you do...drive 45 mins. to the open one....if that is the case....then what is the difference to bringing them to the diversion hosp. and having them wait.....and what good would it do if you are out of service for hours also and your coverage area has no emergency service.....as with CNTY fire stuff...this is where the state has to step in and start dealing with this and not just pretend like it doesn't exist.

[Guest x901]

Just to clarify what Pudge3311 said, there are hospitals in the Southern Westchester area who do go on Diversion bc they are understaffed in the ER, they will continue their diversion until the next shift comes in.....

or then there is the hospital that is lazy.

What really pisses me off is a certain Hospital in Bronxville that thinks that they are above reproach and everyone is required to stay away from that facility, they are nasty to pts, EMS, civillians, whoever. I had a Cardiac Arrest and called them to tell them that i am coming and got YELLED at and then hung up on prior to even telling them what i had. Even when they aren't on diversion it is a fight with that Hospital. And just to note it's not just me, it's all of the agencies in that vacinity that have this problem.... (don't get me started on them when they find out that you are coming in w a homeless drunk!)

[Pudge3311 5]

901, you and I know all too well. Thats why I work the nights I work, the Doc and staff those nights are usually pretty good.

Speaking of, I brought a patient in yesterday at 8am, there were four patients in the ER and we had to wait 20 minutes for a nurse who was sitting in a chair to take a report. On top of that, she made it seem that we interupted her while she was doing CPR on your arrest.

[x648eng119 2]

AS OF 1740Hrs on 1/4/04 -

On Diversion:

Lawrence

United :roll:

Northern Westchester

Phelps

Mt Vernon

[Guest DG795]

Pt's have a right to go to the facility of their choice as long as it is within the boundaries of protocols. Inform the PT that the facility of their choice is overcrowded and may not be able to provide an adequate level of care and offer an alternative; If the PT still wants to go, off we go.

When did ER staff suddenly start thinking that diversion was a padlock on the front door? (figurative)

Also, ambulances dont "go on diversion" when they are being pulled from the ER for their 11 job of the evening. Some (not all) ED staff needs learn to to make it happen under less than ideal conditions, and fight it on an administrative level, not with the ambulance crew.

[Pudge3311 5]

very well put DG796, very well put. =D> =D>

[roeems87 0]

Just to add to 901 and Pudge, I think some of the problems with these hospitals are that they have the same attitude towards patients when they are not on diversion as when they are. Not for anything, perhaps you're having a bad day (perhaps even a busy day, we'll cut some slack), so we'll take the attitude once or twice, but when you have the attitude every day, then it becomes an issue with me (and I know others). I can't believe the attitude we get sometimes walking in with a patient. It's as if we are offending them by bringing in a patient (you know where I am talking about). Not for anything, IT'S THEIR JOB TO TREAT PATIENTS, THEY'RE AN EMERGENCY ROOM. So how in God's name can they get mad when you are bringing them patients. If we stopped bringing them patients entirely, they might see their job go out the window, then they might complain a bit more.

Not only that. I can't stand it when the situation like is on now, the attitudes run higher. When all of the area hospitals are on diversion...we have to pick one. Sorry if it ends up being yours, but when we walk through the door and get a print out saying they are on diversion I want to throw it right back and point out that every other hospital within 25 minutes is also on diversion.

We're doing our best for the treatment the patient is going to get. Whatever hospital that means we bring them to, that's where they go, end of story, the diversion is just another factor added into that.

On a side note, the deal about bringing in a code and getting hung up on, I am not surprised at all, and if I can predict what happened, when you rolled through the door, they were offended that your patient had to be taken care of first. If they could get away with it, they might just send him to triage (intubated and in arrest), he can wait on line too, "we're on diversion you know."

[Guest WolfEMT]

It's funny because the night this topic and discussion were posted, I was bringing in my 85 year old aunt into Westchester Square Hospital (NY Presbyterian Bronx Division) for pneumonia. She was brought in via Metrocare so she didn't have to wait in the waiting room, but I did because they wouldn't let me back to see her; there were many sick/flu cases including serveal peds cases. Westchester Square Hospital put themselves on full divert and stopped taking walk-in ED patients from 1900-2330 last night. As DG795 said, how does that diversion status become a padlock for the front door?

[Guest]

How many times have you walked into that certain hospital in Bronxville to find yourself face to face with that lovely woman whom always seems to be working when they are on diversion. Then she decides to brighten up your day by informing you how you have ruined hers.

I used to take diversion seriously, now I don't because of her. Diversion is what hospitals hide behind when they catch themselves with their pants down. (For the most part).

How many times have you walked into a hospital on diversion only to find there are no patients in the ED?

As long as you inform the patient they are on diversion, and that there will be a wait, and that they have to sign the back of your ACR releasing you from any legal action, they can go whereever they want. If the nurse feels like she is going to make you wait because "she's on diversion," tough for her.

Nothing quiets a nurse like getting on the air and telling central that you need a supervisor because the emergency room isn't recieving any more patients a/p nurse so and so.

Remember, cover your own bases, dont worry about covering the administrators.

[DRD 0]

Article today in the Journal News, 1/5/05 on recent hospital diversions in Westchester and Putnam.

[WAS967 97]

http://www.nyjournalnews.com/newsroom/0105...5diversion.html

Jammed hospitals divert ill

Rerouting the sick

The following hospitals were on diversion as of 2:30 p.m. yesterday, asking ambulances to go elsewhere. The request is not a mandate. Ambulances can go to the hospitals at their own discretion.

• Lawrence Hospital Center, Bronxville

• Northern Westchester Hospital, Mount Kisco

• St. John's Riverside Hospital, Yonkers

• Mount Vernon Hospital

• New York United Hospital Medical Center, Port Chester

 

By MELISSA KLEIN 

THE JOURNAL NEWS 

(Original publication: January 5, 2005)

Coughing, congested and feverish people have flocked to Westchester County emergency rooms in the last few days, prompting many hospitals to ask ambulances, at least at some point, to take the sick elsewhere. 

As of midafternoon yesterday, five hospitals had gone on what's called diversion, telling ambulance companies they were full. 

Phelps Memorial Hospital Center in Sleepy Hollow had been on diversion for 23 hours, opening up again at 7:45 a.m. yesterday. 

"The hospital is jampacked with patients. We couldn't move them upstairs," Dr. Emil Nigro, head of the hospital's emergency department, said yesterday afternoon. "Just no way of handling all these patients. Impossible." 

By 5 p.m. yesterday, the hospital again was on diversion, with 11 patients waiting for rooms. 

Emergency room doctors said patients had a variety of ailments including bad colds, pneumonia and gastrointestinal maladies, and some cases of flu. 

"We've had folks coming in who have been sick for over a week," said Dr. Ray Iannaccone, director of emergency services at Hudson Valley Hospital Center in Cortlandt. "And it still seems to be just a viral illness." 

With beds full, the hospital went on diversion Monday night and reopened to ambulance traffic about noon yesterday. 

Some speculated that the rush to area hospitals was prompted by people declining to seek treatment during a holiday week. 

"They put it off, put it off and put it off," said Ted Tully, director of emergency services at Westchester Medical Center in Valhalla. "And here it is after New Year's and now everyone's deciding, 'Hey, it's so bad, I've got to go to the emergency room.' " 

Tully said the hospital's emergency department volume Monday and yesterday was about 50 percent higher than usual. The medical center, the region's highest-level trauma center, does not go on diversion. 

"There's really no place else to send them if they can't come to us," Tully said. 

In Putnam County, the emergency department at Putnam Hospital Center in Carmel was busy yesterday but not on diversion. 

Westchester County tracks hospitals on diversion through a computer system used by all of the emergency departments and ambulance companies. Even on diversion, hospitals still will accept walk-in patients, and ambulances can bring in patients at their discretion, especially if an illness is life-threatening. 

"We've been monitoring it closely," Tony Sutton, the county's commissioner of emergency services, said yesterday. "Actually, at one point (Monday), half of the county's hospitals were on diversion." 

Jim O'Connor, senior vice president for the TransCare Ambulance service based in White Plains, said the company puts more ambulances and personnel into a municipality where a hospital is on diversion. 

"We understand it's going to be longer transport times for us (to) whatever the next hospital might be," O'Connor said. "Sometimes, you're going two hospitals away." 

O'Connor, who also is chairman of the Westchester County Regional EMS Council, said ambulance companies and volunteer corps were working together to cover one another's territories. 

"If we're grateful for anything, we're grateful the weather's been good," he said. 

As of 2:30 p.m. yesterday, Lawrence Hospital Center in Bronxville, Northern Westchester Hospital in Mount Kisco, St. John's Riverside Hospital in Yonkers and Mount Vernon Hospital were on diversion. New York United Hospital Medical Center in Port Chester, which announced last month it will close early this year, has been asking ambulances for several weeks not to use the facility. 

The situation at United has sent about 20 additional people a day to the emergency room at White Plains Hospital Center. The hospital was on diversion Monday night as 23 people waited for a room, said Jon Schandler, the hospital's president. 

"People kept pouring in," he said. 

It was back on diversion yesterday afternoon, according to the county. 

The emergency room at Northern Westchester Hospital has been busy for the past week, with many elderly people having difficulty breathing and younger patients with gastrointestinal illnesses, said Dr. Robert Marcus, the emergency department's director. The hospital went on diversion Monday night and remained so yesterday. 

"The community doctors are overwhelmed, too," Marcus said. "This is not an isolated emergency department problem. It usually indicates there's something in the community, like some type of virus that's causing serious problems." 

Send e-mail to Melissa Klein 

[Guest alsfirefighter]

First, lets all keep in mind that we are suppose to be PROFESSIONALS.

Some of the comments that I just read were some of the most ridiculous and unprofessional comments I've seen on here. Diversion isn't your problem, it isn't the hospitals problem. ITS YOUR PATIENTS PROBLEM. Whether you patient request to go somewhere or not, whehter someone pissed you off or not, isn't your patients problem. Conduct yourself like a professional and discuss to them the reasons why its not a good idea to go to a facility that cannot give them DIFINITIVE CARE, whether you have an opinion or not why that can happen or not. Hospitals go on diversion gang, its a fact of life, get used to it. Some of us whom have worked other systems, NYC etc., know that it is often a daily occurrance. You have a responsibility to your patient, that is whom you are there for. I can speak for myself, that I will only bring a patient into a facility on diversion if I feel that they cannot take an extended transport due to the need for immediate stabilization that I either cannot gain or is above my level of treatment. Hey if they want to get pissy on that, oh well, I get paid good money to do what I do and they will forget about it tomorrow.

The other thing is this again, when multiple go on in the same area, then we need to have a system agreed upon on a county level. Each hospital goes on a rotation to receive patients one at a time, call by call. This is where a county wide dispatch system is needed.

[Guest x901]

Heres the problem from I287 down to Pelham Parkway in the BX there are about ONE MILLION People (or more) but Hospital beds for something like 3500 (give or take). On monday at one point SJMC, SJRH, CHDF, WPHC, United, Lawerence, TMVH, SSMC were all on diversion, i'm sure the North Bronx Hospitals were full as well. Those of us who work down here really don't have the luxury or the ability to take a patient out of their general area, take them 30minutes or more away who can't afford to pay for the return trip. During this period we were overwhelmed w calls, thus resulting in people going to the hospital. Hospitals all know that these people need to go somewhere... where should we take them? This is the nature of the beast, they all have to go somewhere and most are unwilling to go to another hospital.........

As to that Hospital in Bronxville, we have been having a problem w them for years! On or off diversion those people are down right nasty. They are nasty to eachother (i personally witnessed the CNM yell at an ED nurse which made her cry), they are nasty to the patients they are nasty to us (EMS)..... God forbid they have to lift a finger and work.... Tom wrote about only taking his pts to Hospitals on diversion if they are unstable, well guess what Lawerence tried refusing a cardiac arrest, they have refused to accept the homeless drunk, they sat and watched a person having an acute asthma attack be intubated in their ED by Paramedics bc they were on diversion and couldn't be bothered...... Lawerence hospital is a fight everytime i go in there.

[Guest]

If I get dispatched to a call that is say six blocks from hospital one, and twenty blocks from hospital two, I'll ask the patient where they want to go. Let's say that the patient really wants to go to hospital two. We've all heard the storys, "My records are there," "My doctor is there," "The food is better there," etc.

I'll take the patient to the hospital of their choice, within reason, every time. If I see that the hospital they want to go to is on diversion, I'll tell them that the hospital is backed up, and they are requesting not to recieve any more patients. I also inform my patients that they have a right to go to the hospital of their choice, and cannot be refused. They may have to wait, but I will gladly take them.

I in no way tell my patients that there is no way they are going to their first choice hospital.

You be the one to try and convince these people that they need to go to a hospital they will have to take a train and a cab back from instead of the one within walking distance. One they have never been to instead of the one they always go to. That's why there is telemetry, thats why there are releases. You explain to people that they will wait, and if they agree, then you take them. You don't tell them its your way or the highway.

Diversion is a courtesy, and if people understand that there is going to be a wait, and they release you, what's the sense in picking a fight, or having them "get pissy"? Your not paid to dictate to people where they go when they are stable. You can suggest, you can offer a better option. But at the end of the day THATS what you get paid to do. To give difinitive care within the scope of your protocols. Wether or not a 911 recieving hospital is no longer equipped to give difinative care isn't your primary concern with a stable patient. If you have a stable patient, your job is to get them to the hospital. And last time I looked, taking someone to a hospital they didnt want to go to wasn't a remac protocol. For stable patients, hospital diversion is just a courtesey.

901 said it best. The farther south you go the farther true it gets. I'm not jeporadizing my patients care by taking them where they want to go when they are stable. 9 out of 10 times in BUSY systems the patient requires no care from the crew, and we act as cab drivers. I'll take them where they want to go because it's their right. This only applies to stable patients mind you. Let them go where they want to go, they've been told they are going to wait. Who are we to make them go somewhere else against their will. Abduction wasn't in my job description.

[x648eng119 2]

The situation seems to be improving. As of 1554 on 1/5/04, United Hospital is the only one on diversion. WCDES has suspended all diversions due to inclemet weather. =D> =D> =D> =D>

[Guest alsfirefighter]

You convince them that they need to go....

Before I answer that, let me ask some of you this: Why is that when a hospital is on diversion, its a big deal to some to take them elsewhere, or as soon as a patient requests to go to a hospital that is just it and off you take them? Do you do that with a trauma patient you have to ground transport to WMC? NO. Why? They need the difinitive care offerred at the medical center. IT IS NO DIFFERENT THEN THE MI OR STROKE WHEN YOUR CLOSEST FACILITY IS ON DIVERSION!

I often do. Its part of informed consent. If there is one thing that I'm also known for as a paramedic, its having good patient connection. I explain things to my patients and I stay very patient within context of their personality and call type. If they have a condition which I sincerely believe that taking them to a hospital that is on diversion, no matter how strongly they request to still go there, I will take the time to explain to them why I feel it is necessary and a better choice of judgement to go to the next. I also don't get caught up with the my doctor is there routine. I explain to them that their doctor is also well aware of the situation at the hospital they have practice authority at also. We all know that they are part of the problem. I worked at a hospital that was just on diversion, and often heard practices holding rooms for patients of that practice hoping that if they discharged 1 they would get a room for one of the holds in the ER.

Again, it comes down to professionalism. If you are a Paramedic, you have an obligation to discuss with your patient, their condition, what you are going to do, and why you feel transporting the patient to a farther hospital is necessary.

[Guest x901]

as of 1700 hours all hospitals in Westchester were taken off diversion as per the NYSDOH & WREMSCO for the next 48 hours.....

[mikerabbit 2]

I guess the story got enough media coverage to make the state and county act!

[WAS967 97]

Uhm, no. If you read the memo, it was specifically stated that it was a direct result of the weather. There was also mention of the strain that the diversions are putting on the various systems, but the weather is predicted to greatly worsen said strain, ergo the 48 hour diversion cancellation.

[gpdexplorer 46]

A heard a rumor that the county was going to revamp the diversion plans. No more than 4 hospitals could be on diversion at once and that two hospitals that lay next to each other cannot be on diversion at the same time (i.e. Phelps and Dobbs Ferry). I also heard that someone from the county would have to go and approve the hospital to go on diversion.

Does anyone know if this is true?