Hospitals in areas with large minority populations are more likely to be overcrowded and to divert ambulances, delaying timely emergency care, according to a multi-institutional study focused on California.
The researchers examined ambulance diversion in more than 200 hospitals around the state to assess whether overcrowding in emergency rooms disproportionately affects racial and ethnic minorities. They found that minorities are more at risk of being impacted by ER crowding and by diversion than non-minorities.
The study will be published in the August issue of Health Affairs.
"Our findings show a fundamental mismatch in supply and demand of emergency services,'' said lead author Renee Y. Hsia, MD, assistant professor of emergency medicine at UCSF. She is also an attending physician in the emergency department at San Francisco General Hospital & Trauma Center.
"If you pass by a closer hospital that is on diversion for a hospital 15 minutes down the road, you are increasing the amount of time the patient is in a compromised situation," Hsia said. "It puts these patients at higher risk for bad health outcomes from conditions like heart attacks or stroke, where minutes could mean the difference between life and death.''
Ambulance diversion is triggered when a hospital's emergency department is too busy to accept new patients -- ambulances are rerouted to the next available ER, sometimes miles away. It is especially common in urban areas, particularly in recent years as demand for emergency care has risen.
This is the first study using hospital-level data to show how diversion affects minorities, the authors said.
The scientists looked at emergency departments at all of California's acute, nonfederal hospitals operating in 2007. Pediatric hospitals were excluded because they typically do not treat adults, as well as hospitals in counties that forbid the practice of ambulance diversion. Altogether, the study involved 202 hospitals in 20 counties where diversion is permitted - the majority of them are not-for-profit facilities.