ReviewThe western journal of emergency medicine2013
Reducing ambulance diversion at hospital and regional levels: systemic review of insights from simulation models.
Review in The western journal of emergency medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed.
- Modeling IN out-of-hospital emergency medical services-a scoping review of approaches and applications.Frontiers in public health · 2026Article
- Ambulance diversion and its use as an ED overcrowding mitigation strategy: Does it work? A scoping review.International journal of emergency medicine · 2025Review
- Association of emergency intensive care unit occupancy due to brain-dead organ donors with ambulance diversion.Scientific reports · 2025Article
- The emergency medical service dispatch recommendation system using simulation based on bed availability.BMC health services research · 2024Article
- Effect of Designating Emergency Medical Centers for Critical Care on Emergency Medical Service Systems during the COVID-19 Pandemic: A Retrospective Observational Study.Journal of clinical medicine · 2022Article
- Centralized Ambulance Destination Determination: A Retrospective Data Analysis to Determine Impact on EMS System Distribution, Surge Events, and Diversion Status.The western journal of emergency medicine · 2021Article
- Centralized Ambulance Diversion Policy Using Rolling-Horizon Optimization Framework to Minimize Patient Tardiness.Healthcare (Basel, Switzerland) · 2020Article
- A review on ambulance offload delay literature.Health care management science · 2019Review
- Is Inpatient Volume Or Emergency Department Crowding A Greater Driver Of Ambulance Diversion?Health affairs (Project Hope) · 2018Article
- Closure simulation for reduction of emergency patient diversion: a discrete agent-based simulation approach to minimizing ambulance diversion.European journal of medical research · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionOptimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion.
methodsDATA SOURCES: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. STUDY SELECTION: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. DATA EXTRACTION: Independent extraction by two authors using predefined data fields.
resultsWe identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion.
conclusionSmoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals are promising avenues for reducing diversion.
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.