The effect of an ambulance diversion ban on emergency department length of stay and ambulance turnaround time

Ann Emerg Med. 2013 Mar;61(3):303-311.e1. doi: 10.1016/j.annemergmed.2012.09.009. Epub 2013 Jan 24.


Study objective: Massachusetts became the first state in the nation to ban ambulance diversion in 2009. It was feared that the diversion ban would lead to increased emergency department (ED) crowding and ambulance turnaround time. We seek to characterize the effect of a statewide ambulance diversion ban on ED length of stay and ambulance turnaround time at Boston-area EDs.

Methods: We conducted a retrospective, pre-post observational analysis of 9 Boston-area hospital EDs before and after the ban. We used ED length of stay as a proxy for ED crowding. We compared hospitals individually and in aggregate to determine any changes in ED length of stay for admitted and discharged patients, ED volume, and turnaround time.

Results: No ED experienced an increase in ED length of stay for admitted or discharged patients or ambulance turnaround time despite an increase in volume for several EDs. There was an overall 3.6% increase in ED volume in our sample, a 10.4-minute decrease in length of stay for admitted patients, and a 2.2-minute decrease in turnaround time. When we compared high- and low-diverting EDs separately, neither saw an increase in length of stay, and both saw a decrease in turnaround time.

Conclusion: After the first statewide ambulance diversion ban, there was no increase in ED length of stay or ambulance turnaround time at 9 Boston-area EDs. Several hospitals actually experienced improvements in these outcome measures. Our results suggest that the ban did not worsen ED crowding or ambulance availability at Boston-area hospitals.

Publication types

  • Multicenter Study

MeSH terms

  • Ambulances / organization & administration
  • Ambulances / statistics & numerical data*
  • Boston
  • Crowding
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data*
  • Health Policy
  • Hospitalization / statistics & numerical data
  • Humans
  • Length of Stay / statistics & numerical data*
  • Patient Discharge / statistics & numerical data
  • Patient Transfer / organization & administration
  • Retrospective Studies
  • Time Factors