COD E R E D

the hospitals were on diversion or caution more than 400 hours a month or 27% of the time. For10 of the months, they were on diversion or caution more than 800 hours or 55% of the time.The hospitals also report the reasons for diversion (medical saturation, traumasaturation, ER saturation) and caution (CT scan down, equip down, no burn beds, nomedical/surgical beds, no neurology beds, no psychiatry beds, no pediatric beds, notelemedicine beds). ER saturation was reported as the reason for 46.1% of all diversion hoursfor these two hospitals over the 2003 - 2005 period.1200Figure1. Diversion & Caution of Level I(Ben Taub & Memorial Hermann), Yr '03 - June '051000Duration Hours8006004002000Month & YearDiversion(plus 2 H)CautionStudies have examined the effectiveness of diversion in reducing the volume of patientstreated at overloaded hospitals ff,gg and the impact of diversion on pre-hospital transit time ofdiverted patients. hh, ii A study completed in Houston found a possible effect of EMS diversion onmortality. jj A comparison was made of death rates of trauma patients hospitalized on significantdiversion days, defined as days when both Level I hospitals were on diversion for more thaneight hours, and non-significant diversion days when one or both hospitals were on diversion forless than eight hours or not on diversion at all. The study found that the percentage of deathsamong all trauma patients, both those transferred and those not transferred, admitted onsignificant diversion days was consistently higher than on non-significant diversion days. Forthe most severe trauma patients who were transferred from another hospital the higher mortalityrate approached statistical significance (p