A University of California, San Francisco study found that California hospitals in areas with large minority populations are more likely to be overcrowded and divert ambulances, delaying timely emergency care.

The study, published in the August issue of Health Affairs, examined ambulance drivers in hospitals around the state to assess whether overcrowding in emergency rooms disproportionately affects racial and ethnic minorities. Researchers say this is the first study using hospital-level data to show how diversion affects minorities, and research found minorities are more at risk of being impacted by ER crowding and by diversion than non-minorities.

Ambulance diversion takes place when hospital emergency rooms are too busy to accept new patients, so they’re rerouted to the closest available ER. This is especially common in urban areas.

Researchers looked at 2007 data from 202 hospitals around the state, which showed hospitals that served the greatest percentage of minority patients turned away ambulances because of overcrowding far more than those that served the smallest number of minorities.

Researchers found that 92% of the hospitals experienced a median diversion of 374 hours over the course of the year. Those serving high numbers of minorities experienced ambulance diversion for 306 hours, compared to 75 hours with fewer minority patients.

Lead author Renee Y. Hsia, M.D., assistant professor of emergency medicine at University of California, San Francisco, notes that these diversions put patients suffering from conditions like heart attack or stroke at a much higher risk. “Minutes could mean the difference between life and death,” she says in a press release.

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There are several reasons that cause emergency rooms to become overcrowded. First, many patients—especially those who are uninsured and don’t have access to primary care services—end up there for less urgent reasons or serious conditions that could have been treated earlier. Additionally, hospitals lack the proper staffi ng to admit patients into the hospital, so patients are stuck waiting. Lastly, hospitals sometimes don’t have the equipment or services needed to treat specifi c medical problems.

The study authors say their research points to the need for systemic reform, including better management of hospital flow and statewide criteria regulating diversion policies.

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