- More than 30 healthcare associations and advocacy groups joined the American College of Emergency Physicians in asking President Joe Biden to prioritize finding solutions to the problem of overcrowded hospital emergency rooms.
- Strained emergency departments are coping with an increase in boarding, a term for when patients are held in the ED longer than they should be because of a lack of available inpatient beds. The problem has led to gridlocked EDs filled with patients waiting, sometimes in life-threatening situations, the ACEP and other groups warned Monday in a letter to the president. “Boarding has become its own public health emergency,” the letter said.
- The organizations urged the Biden administration to convene a summit of stakeholders from across the healthcare system to identify immediate and long-term solutions to the boarding problem.
Rising hospital staffing shortages during the COVID-19 pandemic have heightened stress on physicians and nurses, leading to burnout and an exodus of highly skilled professionals across the healthcare system. The ACEP also has documented a recent rise in violence against physicians in emergency centers.
Emergency room clinicians have pushed Congress to increase regulations to protect them from the rise in violence. Hospital operators are reporting longer lengths of stay for patients, even as overall inpatient admissions have declined.
In recent months, the problem of boarding has reached a “breaking point” with the system headed toward collapse, the ACEP and other groups said in their letter. Patients are waiting to be seen, waiting to be transferred to psychiatric, skilled nursing or other specialized facilities or waiting to return to nursing homes, they added.
The nine-page letter offered examples of situations in which boarding threatened to cause patient harm, including patients in need of intensive care who may board for hours in ED beds not set up for the extra monitoring they need. In addition, those in mental health crises sometimes board for months in chaotic EDs while waiting for a psychiatric inpatient bed to open, the groups said.
When ED beds are filled with boarded patients, other patients are “in some cases, dying while in ED waiting rooms during their tenth, eleventh, or even twelfth hour of waiting to be seen by a physician,” the letter said. It cited evidence that boarding leads to worse outcomes, compromises patient privacy, increases medical errors, delays care and increases mortality.
The Joint Commission, an independent accrediting body for hospitals, identifies boarding as a patient safety risk that should not exceed four hours, yet clinicians report boarding times much longer than that as an almost routine occurrence, the letter said. Emergency patients can find themselves boarded regardless of their condition, age, insurance coverage, income or geographic area, it added.
The groups said they are concerned that in the winter months ahead, the “triple threat” of flu, COVID-19 surges and pediatric respiratory illnesses that are on a sudden rise will overwhelm hospital emergency rooms.
“If the system is already this strained during our ‘new normal,’ how will emergency departments be able to cope with a sudden surge of patients from a natural disaster, school shooting, mass casualty traffic event, or disease outbreak?” the letter asks.