Diverting nonemergency cases from EDs in Canada does little to improve care quality for other patients

Diverting nonemergency cases from emergency departments in Canada does not have much impact on the efficiency or timeliness of care given to sicker patients, according to a study published Wednesday on the Annals of Emergency Medicine Web site, the Houston Chronicle reports.

For the study, lead author Michael Schull of the Institute for Clinical Evaluative Sciences in Toronto and his colleagues examined 4.1 million patients at 110 hospitals in Ontario, Canada, between April 2002 and March 2003 to determine whether care for nonemergency patients "cause[d] slower care for sicker patients," the Chronicle reports.

According to the study, for each nonemergency patient who arrives at an ED, each patient seeking emergency care experiences an increased length of stay of 32 seconds.

Every 10 patients with nonemergency ailments arriving in any eight-hour period added an average of only 5.4 minutes to emergency patients' length of stay and an average of 2.1 minutes to the time emergency patients' spent waiting to see a physician (Ackerman, Houston Chronicle, 8/23).

Schull cast doubt on the idea that nonemergency cases are the main factor behind ED overcrowding, pointing instead to factors such as a lack of inpatient beds, inefficient use of resources and failure to quickly transfer patients to other departments (Roser, Austin American-Statesman, 8/23).

"The take-away message is that the benefit of diverting patients is so small that it isn't worth it.

Caring for patients with minor ailments doesn't lead to clinically important delays and turning them away isn't very patient-focused," Schull said.

Thomas Granchi, medical director of Ben Taub General Hospital Emergency Center in Texas' Harris County, said Schull's findings are "counterintuitive" and do not affect physicians' "assumptions or current knowledge."

He added that the study compares "apples and oranges," as the U.S. and Canadian health systems differ (Houston Chronicle, 8/23).