Full hospitals to stop diverting the critically ill

Critically ill patients in King County from now on will be taken by ambulance to the nearest hospital — even if it doesn't have room for them — instead of riding long distances to find an open bed.

A new policy, adopted by a countywide emergency-services council, means hospitals no longer will "divert" incoming patients to other hospitals when their own emergency departments are crowded or when they don't have critical-care beds or sufficient staff.

Instead, hospitals have agreed to treat and stabilize critically ill patients, then have them transported to a hospital that has an appropriate bed available.

Under the old policy, paramedics and other emergency-service workers complained they often had to transport patients with suspected heart attacks or other life-threatening problems so far that it was dangerous to patients and put ambulances out of service for long periods, said Chris Martin, chairwoman of the Central Region Emergency Medical Services & Trauma Care Council.

"We all agreed that philosophically, it was not OK, and ethically, it wasn't OK," Martin said. "We're going to take the word 'divert' totally out of our vocabulary."

Martin said some hospitals were on "divert" status, meaning they were refusing emergency patients, 20 to 25 percent of the time. For hospitals, the problem most often wasn't that their emergency rooms were too crowded, but that there weren't enough beds to move patients out of the emergency area.

"It's not that the emergency department couldn't take them in, it's that they couldn't get them out," Martin said. "If you don't have beds you can admit them to, you're really at gridlock."

The new policy won't affect trauma patients such as those in automobile accidents, Martin said. They are transported to hospitals according to a different system that matches the seriousness of the injury with a hospital's trauma-level designation.

A number of factors play into rising rates of emergency-department crowding, Martin said, including a nursing shortage, increasing numbers of uninsured or Medicaid patients, and refusals by specialists to treat them.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com