Indiana hospitals will no longer routinely turn away ambulances because their emergency departments are overcrowded, a statewide change health officials say will give patients and EMS crews more flexibility in deciding where to seek care.
The change took effect Sept. 1 and ends what health officials call crowding-based ambulance diversion.
Dr. Eric Yazel, chief medical officer of public health practice for the Indiana Department of Health, said diversion previously allowed an emergency department to notify local EMS agencies that it had reached capacity and was no longer accepting ambulance traffic.
Under the new system, an overcrowded hospital can still tell EMS crews that it is extremely busy, but that information is considered an advisory rather than an automatic reason to take a patient somewhere else.
"Hey, that facility is very full, but if you have some need to go there, you're still allowed to go there," Yazel said.
That can be particularly important for patients who already receive care from a specific hospital.
Yazel used the example of a cancer patient undergoing chemotherapy who has an established treatment team and medical records at one facility. Under the previous system, that patient could be taken elsewhere if their usual hospital was on diversion.
Yazel described routine diversion as a blunt approach to overcrowding.
"Diversion is kind of a rudimentary tool, to be honest," Yazel said. "It's kind of an all-or-nothing approach, right? Everything can come here, and then all of a sudden, nothing can come here."
Instead, state health officials want hospitals and EMS agencies communicating about capacity and determining which facility makes the most sense based on an individual patient's needs.
The change does not eliminate ambulance diversion entirely.
Hospitals can still turn away ambulances when emergencies or critical infrastructure problems prevent them from safely treating patients. Yazel said examples could include flooding, unavailable critical equipment or other circumstances that prevent a hospital from providing appropriate care.
"The key to this is this should all be patient centered," Yazel said.
Ending routine diversion also doesn't eliminate emergency department overcrowding. Yazel said hospitals will have to manage high patient volumes through other measures, including opening additional beds when possible and improving patient flow.
He said diversion could provide temporary relief to an overwhelmed emergency department but could create problems elsewhere in the health care system.
"Diversion just provides a chance to catch your breath, but actually can cause some bigger problems down the road," Yazel said.
