by Alexander T. Janke, Jennifer Tsai, and Kristen Panthagani: For Complete Post, Click Here…
We call on HHS and CMS to help address the issue of ED boarding.
A special session of Congress was called 35 years ago to make lawmakers and the public aware of stories of patients left to die in hospital parking lots for lack of insurance. Around the time of that congressional testimony, called “Equal Access to Health Care: Patient Dumping,” a new guarantee came about: that any individual who comes to the emergency department (ED) must be givenopens in a new tab or window a medical screening evaluation and appropriate stabilization. This codifies the ED, by federal lawopens in a new tab or window, as the front door to hospital-based care in the U.S.
In its ideal form, the ED is well-calibrated for the rapid identification of life- and limb-threatening acute illness and injury. For the vast majority of patients, no such dangerous pathology is present, and for a small subset of the sickest patients, our core mission is resuscitative care. After that, we act as a flexible acute diagnostic and therapeutic center that ends in disposition: discharge or hospital admission.
But what happens when there aren’t any open beds upstairs, on the inpatient side? As most of us have seen all too often, hospitals’ preferred fix is to have patients pile up, waiting in the ED until rooms open up. This is what we call “boarding,” and it is an ever-present threat to our role in the resuscitative care of the sickest patients. As the mismatch between acute care needs and available capacity mounts, our work environment descends to chaos.
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A special session of Congress was called 35 years ago to make lawmakers and the public aware of stories of patients left to die in hospital parking lots for lack of insurance. Around the time of that congressional testimony, called “Equal Access to Health Care: Patient Dumping,” a new guarantee came about: that any individual who comes to the emergency department (ED) must be givenopens in a new tab or window a medical screening evaluation and appropriate stabilization. This codifies the ED, by federal lawopens in a new tab or window, as the front door to hospital-based care in the U.S.
In its ideal form, the ED is well-calibrated for the rapid identification of life- and limb-threatening acute illness and injury. For the vast majority of patients, no such dangerous pathology is present, and for a small subset of the sickest patients, our core mission is resuscitative care. After that, we act as a flexible acute diagnostic and therapeutic center that ends in disposition: discharge or hospital admission.
But what happens when there aren’t any open beds upstairs, on the inpatient side? As most of us have seen all too often, hospitals’ preferred fix is to have patients pile up, waiting in the ED until rooms open up. This is what we call “boarding,” and it is an ever-present threat to our role in the resuscitative care of the sickest patients. As the mismatch between acute care needs and available capacity mounts, our work environment descends to chaos.
Patients are now waiting hours, days, and sometimes weeks in the ED. It’s like asking a teacher to take on a whole new class of students when last year’s class hasn’t left yet.
New data from two studiesopens in a new tab or window we recently published in JAMA Network Open document what patients, nurses, and doctors already know: the levees have broken. The system has collapsed under the weight of acute care needs.
At the end of 2021, in the hardest-hit hospitals, more than one in 10 ED patients left without careopens in a new tab or window. Half of the sickest patients in the department — those requiring admission — waited 9 or more hoursopens in a new tab or window for an inpatient bed. More and more, patients are placed in hallways: patients who need sensitive exams, patients with highly infectious respiratory viruses, and elderly patients with sepsis who must endure the bright hall lights through the night.
The problem isn’t just physical space — it’s staff.
