A wave of sick elderly people and a mix of winter illnesses in January combined to shatter the previous record for ambulance diversions at Greater Cincinnati hospitals.

        Eleven hospitals in Hamilton, Butler and Clermont counties went on diversion 82 times in January, according to the Greater Cincinnati Health Council.

        That's a 44 percent increase over the previous record of 57 in November and about twice as many as January 2000.

        A diversion means a hospital has asked life squads to take as many patients as possible somewhere else for all or part of an eight-hour shift.

        The increase in diversions means it can take longer for life squads to get people to a hospital. It also means extended waits for care for “walk-ins,” or those with non-life-threatening problems who drove themselves or a loved one to a hospital.

        The diversions are occurring for several reasons, said Colleen O'Toole, vice president of the council.

        Hospitals continue to struggle to hire enough nurses and other staff to meet demand even though they are paying overtime, hiring temps and calling in managers with nursing degrees to help with patient care.

        Severely ill patients are filling up limited numbers of intensive care beds, which causes back-ups in emergency departments.

        Meanwhile, lots of people seem to be getting sick in lots of ways, she said.

        While influenza remains lower-than-expected for this time of year, a wave of gastrointestinal illness has hit many parts of town, sometimes strongly enough to force schools to close. Meanwhile, hospitals have been especially busy treating heart attacks, strokes and pneumonia, especially among elderly people.

        “Most often we've had intensive care units filling up, so the emergency department ends up holding people,” Ms. O'Toole said. “We're seeing hospitals operating temporary ICUs in their emergency departments.”

        The health council tracks diversions at 14 hospitals that share emergency communication systems.

        There are exceptions. For example, life squads can ignore diversion requests when they have unstable patients or when the patient insists on a particular hospital. Hospitals clustered in different parts of town also have agreed not to go on diversion all at once.

        By law, hospitals cannot turn away patients who walk in to an emergency room.

        In January, the hospitals with the most diversions were Jewish Hospital in Kenwood and the VA Medical Center in Corryville, each with 21; and Mercy Franciscan Mount Airy, with 11.

        In Northern Kentucky, no hospitals went on diversion in January, but they've been busy.

        “Volumes were way up,” said Karla Webb, spokeswoman for St. Elizabeth Medical Center. “There were times we looked into (going on diversion). But when we needed to, we'd check with other hospitals and find there was no place for the patients to go.”

        With more wintry weather yet to come, hospital officials see few signs of relief.

        Influenza has yet to peak in Greater Cincinnati. When it does, hospitals plan to seek approval to put flu patients in beds normally used only for rehabilitation, ambulatory surgery and other specialty services.

        However, a temporary increase in bed capacity won't increase the number of nurses.

        “There will be more shifting around (of nurses' duties),” Ms. O'Toole said. “But will there be enough nurses? I can't answer that.”

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