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Hospital Capacity and Emergency Department Diversion: Four Community Case Studies AHA Survey Results April 2004 Executive Summary This report includes the findings from the second of two studies initiated by the American Hospital Association (AHA) on emergency department (ED) capacity constraints and ambulance diversions.1 This study seeks to look specifically at communities’ hospital capacity and how it changes by day and time of day to get a better understanding of the multiple factors that are leading to ED diversions. 28 hospitals in 4 communities were asked to track inpatient and ED capacity as well as ED diversions at various times over a three day period. Over 50 percent of hospitals in each community reported that their EDs were “at” or “over” capacity. All communities experienced some level of ambulance diversion, though hours on diversion varied by community. This study illustrates the difficulty hospitals face in anticipating and responding to changing demand. Executive Summary (continued) While lack of critical care beds was the most common reason for diversion, the specific causes of diversion varied by community and by hospital at specific points in time. Other factors that led to diversion included: ED overcrowding Staff shortages Closure of other facilities RN vacancy rates by community were generally higher in the ED than in the facility as a whole and hospitals with the highest rates of diversion had higher RN vacancy rates. Hospitals reporting being “at” or “over” capacity in the ED had longer waiting and boarding times. Average occupancy based on a midnight census fails to reflect volume fluctuations by day and time of day. Background Purpose In 2002, the AHA conducted a national survey of hospitals to get a better understanding of the growing problem of emergency room capacity constraints and ED diversions. This national study found that: Nearly 80 percent of urban hospitals described their EDs as at or over capacity1 More than half