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{
    "pk": 7473,
    "title": "Reducing Ambulance Diversion at Hospital and Regional Levels: A Systematic Review of Insights from Simulation Models",
    "subtitle": null,
    "abstract": "Introduction: \nOptimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion.\nMethods: \nData Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields.\nResults: \nWe identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion.\nConclusion: \nSmoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals. [West J Emerg Med. 2013;14(5):489-498.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution-NonCommercial  4.0",
        "short_name": "CC BY-NC 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by-nc/4.0"
    },
    "keywords": [
        {
            "word": "Ambulance diversion, ED crowding, simulation models, patient flow, operations research"
        },
        {
            "word": "Emergency Medicine"
        }
    ],
    "section": "Prehospital Care",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/41g6m81s",
    "frozenauthors": [
        {
            "first_name": "M. Kit",
            "middle_name": "",
            "last_name": "Delgado",
            "name_suffix": "",
            "institution": "Stanford University, Division of Emergency Medicine, Stanford, California",
            "department": "None"
        },
        {
            "first_name": "Lesley",
            "middle_name": "J.",
            "last_name": "Meng",
            "name_suffix": "",
            "institution": "Columbia University, Mailman School of Public Health, New York City, New York",
            "department": "None"
        },
        {
            "first_name": "Mary",
            "middle_name": "P.",
            "last_name": "Mercer",
            "name_suffix": "",
            "institution": "University of California San Francisco, San Francisco General Hospital, San Francisco, California",
            "department": "None"
        },
        {
            "first_name": "Jesse",
            "middle_name": "M.",
            "last_name": "Pines",
            "name_suffix": "",
            "institution": "George Washington University, Department of Emergency Medicine and Health Policy, Washington, DC",
            "department": "None"
        },
        {
            "first_name": "Douglas",
            "middle_name": "K.",
            "last_name": "Owens",
            "name_suffix": "",
            "institution": "Stanford University, Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford, California",
            "department": "None"
        },
        {
            "first_name": "Gregory",
            "middle_name": "S.",
            "last_name": "Zaric",
            "name_suffix": "",
            "institution": "University of Western Ontario, Department of Epidemiology and Biostatistics and the Richard Ivey School of Business, London, Ontario, Canada",
            "department": "None"
        }
    ],
    "date_submitted": "2012-06-12T00:14:42Z",
    "date_accepted": "2012-06-12T00:14:42Z",
    "date_published": "2013-09-15T07:00:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/7473/galley/4416/download/"
        }
    ]
}