Background:

Emergency Department (ED) overcrowding is a widespread problem. Since hospitalists are expert at navigating complex systems of care, we hypothesized that early involvement of hospitalists in the ED could decrease overcrowding. We present data on ambulance diversion time as a marker of the impact of our intervention.

Method:

In July 2005, we implemented a medicine admitting team whose purpose was to coordinate the flow of medicine admissions from the ED while also improving initial care of patients. The team is composed of a hospitalist attending and an internal medicine resident. It is staffed at all times and closely interacts with care coordination and social work.

We tracked performance metrics via standard ED and health system reports. We used adult med/surg diversion time as our primary performance measure. Pediatric diversion time was used as a control. Diversion decisions are made by the ED clinical coordinators and attending physicians. We combined the daily diversion time from July 1 to December 31 into a six‐month total diversion time.

Data were compared using two‐tailed paired Student's t‐tests.

Summary of Results:

The six‐month total adult med/surg diversion time for the last half of 2004 compared to the last half of 2005 decreased from 1383 hours to 551 hours. Diversion hours decreased each month (p = 0.010 for paired comparison of average monthly diversion time). Comparison of pediatric diversion time over the same time periods showed a non‐significant decrease of 36 hours (p = 0.664). Comparison of six‐month diversion time between adult med/surg and pediatric diversion time showed a significant decrease in adult med/surg diversion time (p = 0.0125). Over this time period, total admissions increased by 697 and ED volume increased by 3581 visits.

Statement of Conclusions:

We implemented a medicine admitting team whose initiation corresponded with a large decrease in adult med/surg diversion time. A control group, concurrent pediatric diversion time, showed little change. This improvement was seen despite increased volume of ED visits and admissions. Further study is needed to delineate the power of the medicine admitting team as an extension of hospitalists into the ED.

Author Disclosure Block:

A. Dow, None; A. Erskine, None; C. Banas, None; V. Ramachandran, None; S. Call, None.