San Diego County Patient Destination Trial. Gary M. Vilke, M.D. Associate Professor of Clinical Medicine Interim Medical Director, San Diego County EMS. Acknowledgements. Edward M. Castillo, PhD Theodore C. Chan, MD Roneet Lev, MD Marcelyn A. Metz, RN Patricia A. Murrin, RN, MPH.
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Gary M. Vilke, M.D.
Associate Professor of Clinical Medicine
Interim Medical Director, San Diego County EMS
Without the luxury of additional funding!
Vilke GM, Simmons C, Brown L, Skogland P, Guss DA: Approach to decreasing emergency department ambulance diversion hours. Acad Emerg Med 2001;8(5):526
Week Before Test Week Week After P-Value
Hosp A Diversion hrs 19.6 1.4 39.4 p<0.05
Hosp A Diverted pts 19 2 29 p<0.05
Hosp B Diversion hrs 27.7 0 26.3 p<0.05
Hosp Diverted pts 24 0 9 p<0.05
The oscillatory phenomenon, when one hospital went on diversion leading to a disproportionate flow of ambulance traffic to the neighboring facility that subsequently was forced to go on diversion, went away during the trial week.
Vilke GM, Loh A: A prospective study of minimizing ambulance diversion and its effect on emergency department census and hospital admissions. Prehosp Emerg Care 2003;7(1):171.
Week 1 Week 2 Week 3
Ambulance runs 685 717 709
Diversion hours 112.2 0.3 47
No changes in numbers or percents of ED patients, med/surg admissions, ICU admissions.
There were significant decreases in patients being diverted and trends to decreased numbers of patient requiring interfacility transfer out.
No reported “unsafe” events in the ED during the trial week.