Virginia Engineering Magazine, Hospital Study

On Jan. 9, 2001, 12 of the 13 hospital emergency departments in the Richmond area reached capacity and were forced to turn ambulances away.

There was no monitoring system in place to know there was a problem," said Dr. Robert Bennett, a cardiologist and recent graduate of the University of Virginia's Executive Master's Degree Program in systems engineering.

"It wasn't realized until a large number of ambulances were lined up in front of one hospital," he
said.

That incident prompted Bennett and Dr. Gerard Learmonth, the academic director of the program, to study how "diversion" can be prevented. Bennett and 21 other graduate students in the systems engineering program conducted the study, under the direction of professor Christina Mastrangelo.

"The last course is a project-based course that focuses on solving a real-world problem," Learmonth said. "We look to solve problems that have some social benefit."

The issue of diversion qualifies.

"If you're the patient, it's a serious issue," Learmonth said. "You would want to be brought to the nearest appropriate hospital."

Bennett, founder of the Richmond-based Medical Reengineering Inc., noted that problems associated with diversion quickly snowball.

"If your loved one has a heart attack, you call an ambulance. If the ambulance has to search around for a hospital, your loved one is in danger," Bennett said. "But in addition to that, the ambulance cannot respond as quickly to the next call because it is still searching for a hospital to take the first patient to."

The growing occurrence of diversion is attributed to several factors, including an increase in the elderly population, a nursing shortage and non-emergency patients clogging up emergency departments.

"Diversion is a nationwide problem," Bennett said. "There is nothing unique about Richmond. It's true for all metropolitan areas."

The study, which analyzed 2001 hospital and ambulance data, concluded that one key way diversion can be avoided is by trying to predict emergency department patient caseloads on a day-to-day basis.

"Hospitals can be proactive," Bennett said. "If they forecast by looking at data from previous years, they can eliminate the diversion problem."

Bennett estimates that forecasting caseloads could improve staffing efficiency by as much as 15 percent.

"It makes sense to have fewer staff on during low demands and more staff on during high demands," he said.

Having more staff working when patient numbers are high also would allow more hospital beds to be opened, which is critical in moving patients out of the emergency room in a timely manner.

"There's not a problem with the time it takes for rescue squads to get patients to the hospital. There's not a problem with the time it takes to get patients treated in the emergency room," Bennett said. "The problem is with getting the patients out of the emergency room and into a hospital bed once they've been treated."

Jon R. Donnelly, executive director of Old Dominion Medical Services Alliance, the organization that coordinates emergency medical services in Richmond and surrounding areas, recently received a copy of the study. He said he's "very, very impressed" by it.

"They did a thorough job of examining the problem," Donnelly said. "It's the first time the problem has been analyzed in some depth for our area. They have some suggestions that we can use."

Donnelly said the next step will be to distribute the study to Richmond-area hospitals and a diversion task force for consideration.

"It's like having a road map," Donnelly said. "It will help us get where we need to be.