SCOTT SIMON, HOST:
When you call for an ambulance, you might expect the crew to take you to the nearest hospital. But sometimes the closest emergency department just isn't taking new patients. Several hospitals in Cleveland have come together to try to keep ERs open for all the patients' ambulances so they can bring them in. WCPN's Sarah Jane Tribble reports.
SARAH JANE TRIBBLE, BYLINE: It is a run-of-the-mill call for east Cleveland's EMS squad. They're going to treat a man with a severe nosebleed.
ANTHONY SAVOY: One-four-five's enroute, part two.
TRIBBLE: Anthony Savoy is the head medic.
UNIDENTIFIED MAN: (Unintelligible).
TRIBBLE: The patient walks woozily out to the ambulance. Savoy calls ahead to University Hospitals. It's the closest emergency department, and he wants to make sure they have room to take the patient. They get in that day, but it wasn't a given. For years, it's been common practice for UH to go on diversion. That means when he calls the hospital, UH says they don't have the room or the staff to handle the patient. The team then has to drive to another hospital, often the Cleveland Clinic, about a mile away.
SAVOY: If we get diverted and then we get a call while we're at the hospital, our response time will be lengthened by maybe a minute, maybe two minutes.
TRIBBLE: That may not seem like much time, but a minute or two is critical for some patients, says Dr. James Feldman, an emergency medicine doctor in Boston.
JAMES FELDMAN: We have strong evidence that people who have critical illness or injury who have a delayed time to treatment do worse.
TRIBBLE: A study released earlier this year found that heart attack patients whose ambulances were diverted from crowded emergency rooms to hospitals farther away were more likely to be dead a year later. In Cleveland this year, UH temporarily closed its main campus emergency room to certain patients for more than 550 hours. Another large hospital system, MetroHealth, clocked more than 400 diversion hours. Jane Dus, chief nursing officer at University Hospitals, says an aging population and hospital closures have increased demand on emergency departments.
JANE DUS: We've seen a 56 percent increase in our squad volume over five years, so we're getting many more squads coming to us.
TRIBBLE: Dus recently joined Cleveland area hospitals in negotiating an agreement to stop going on diversion. Indeed, all four major health systems in Cleveland say they will accept all ambulances starting February 15 in 2016.
If the hospitals are successful, the region will join a select few that have tackled the issue. After years of effort, the Seattle area has stopped nearly all diversions. Boston's Dr. Feldman says Massachusetts passed relations in 2009 to ban ambulance diversions after voluntary attempts failed. Hospitals there had to re-evaluate operations, in some cases, encouraging elective surgeries to be done closer to the weekends to free up beds on other floors throughout the week.
Changing the way emergency departments respond is complicated because they routinely operate with minimum staffing and beds, Feldman says.
FELDMAN: The staff are reasonably fearful that the next critical patient is going to push them over the brink of patient safety. They really can't handle another patient.
TRIBBLE: Both University Hospitals and MetroHealth are getting ready. Dr. Alfred Connors is at MetroHealth.
ALFRED CONNORS: It's an issue of - do we have enough beds open? Do we have the proper staffing? Do we have the capacity in the emergency room?
TRIBBLE: EMS medic Anthony Savoy is skeptical the hospitals can end diversions. Just hours after Savoy dropped off his nosebleed patient, UH stopped taking all but the most critical injuries for nearly four hours.
SAVOY: My concern is all of a sudden, you guys are willing to put this in paper and say that you're going to do this. What was stopping you guys before? Why now?
TRIBBLE: Savoy and others on the squad are worried that the emergency departments will stay crowded. It's something local leaders say they'll work to avoid. For NPR News, I'm Sarah Jane Tribble in Cleveland.
SIMON: And this story's part of a reporting partnership with NPR, WCPN and Kaiser Health News.