The Crisis of Boarding Patients

In June 2021, a car accident landed me in the emergency room, an unforgettable ordeal seared into memory. Stretched out in a hallway, bathed in harsh lights, I waited amidst the bedlam. What I didn’t realize then was that this scenario unfolds daily for many, emblematic of a widespread issue plaguing emergency departments (EDs) nationwide: boarding patients.

Each day, across America, older adults endure hours—sometimes days—on gurneys in ED corridors, their pleas for aid lost in the chaos. Despite recommendations for hospital admission, they suffer in discomfort, deprived of essential care. This crisis, known as ED boarding, is hitting unprecedented levels, worsening the plight of vulnerable seniors.

ED boarding occurs when patients linger in the emergency department for extended periods, awaiting an inpatient bed or transfer after initial care. These delays, lasting hours, days, or even weeks, imperil patient safety and outcomes. For seniors, who make up nearly 20% of ED visits, the situation is particularly dire. Physicians struggle to provide adequate care as older patients endure pain, hunger, and discomfort.

Before the COVID-19 pandemic, around 10% of patients faced boarding in EDs before receiving hospital care. Among them, 30% to 50% were older adults. This crisis has only worsened, surpassing the challenges of the pandemic. Physicians like Hashem Zikry, MD, paint a grim picture of ER hallways crammed with distressed patients, a significant portion being older individuals.

Root Causes:

  1. Staff Shortages: Hospitals grapple with inadequate staffing, impacting bed availability.
  2. Bed Allocation: Hospital administrators face a delicate balance between patient care and financial sustainability. While prioritizing patient well-being, they must also ensure revenue from elective surgeries and specialized procedures. However, this often leads to tough decisions regarding bed allocation, leaving some patients stranded in the ED.
  3. High Demand: The aging population increases demand for hospital services. Additionally, the influx of undocumented immigrants seeking healthcare strains hospital finances, as they absorb costs without reimbursement. This poses a significant challenge to the sustainability of hospital systems.
  4. Discharge Backlogs: Challenges in securing home healthcare and nursing home placements prolong patient stays.

Solutions and Advocacy: Emergency physicians, led by the American College of Emergency Physicians (ACEP), are spearheading efforts to address this crisis. ACEP’s national summit on boarding emphasizes collaborative solutions. Advocacy targets policymakers, urging constructive approaches to alleviate boarding-related factors.

Advocacy efforts target the White House, Congress, and regulatory agencies, urging constructive approaches to alleviate boarding-related factors.