Strategies For The Management Of Ambulance Diversion And Emergency Department Overcrowding: A Systematic Review

The issue of overcrowding in emergency departments stands out as a critical concern in overpopulated cities. Access block is defined as situations when patients in the emergency department (ED) have no access to appropriate hospital beds within reasonable time despite their needs for inpatient care, leading to overcrowding and ambulance diversion (AD). AD is regarded as a controversial strategy to alleviate ED congestion, curbing the input visits and is executed as a measure when EDs request ambulances to transport the patients to less crowded hospitals. This systematic review gathered the main strategies which are applied in the real world to decrease AD and ED overcrowding. An exploration of PubMed, Medline, and Web of Science databases was undertaken to scrutinize articles from November ۱-۲۵, ۲۰۲۰. Eventually, we found ۱۸ pre and post-intervention studies which developed strategies in real situations to decrease AD in an attempt to reduce ED overcrowding. The findings pointed to the enhancement of agency capacity whether by increasing the number of beds in the emergency room or developing an acute care unit  (ACU) as a new form of controlling patient flow at the back end of the  ED using the AD ban and no-diversion policy, formation of improvement teams, collaboration of hospitals and emergency medical services agencies, and determination of optimal patient destination by a destination-control physician as the main strategies to reduce AD in order to increase ED overcrowding.

کلیدواژه ها:

Medical services agencies ، Emergency department ، Overcrowding ، Ambulance diversion.