ER crowding solutions "grossly underused"

January 12th, 2015

Yet another analysis on ER crowding on wait times was published yesterday and the conclusion…the same as others before it: boarding, the practice of keeping admitted patients on stretchers in ER hallways for hours or days, is the primary cause of emergency department crowding and wait times.

The policy analysis, published in Health Affairs, reaffirmed the dangerous practice of boarding ER patients, calling it “a symptom of interrelated parts of the broader health care system.”

Boarding ER patients has long been associated with worse health outcomes and longer hospital stays and mortality. Part of problem is hospitals view boarded ER patients as less profitable than patients admitted for elective surgeries, etc. David Seaberg, MD, FACEP, president of the American College of Emergency Physicians (ACEP) says, “I just hope that hospital administrators and legislators smell the coffee. Their leadership is critical to changing the flow of patients from the front door of the emergency department to the inpatient floors of the hospital. ”

So what is the solution? The authors recommend that hospitals implement strategies that have been shown to be effective in reducing boarding and overcrowding. They include:

• Moving admitted patients to inpatient hallways;
• Smoothing elective surgery schedules; and
• Active bed management.

By implementing these strategies, boarding in the emergency department could be virtually eliminated. But the authors suggest federal regulation may be required to bring these strategies into widespread use, and suggest that the Centers for Medicare and Medicaid (CMS) could “increase incentives for improvements in patient flow.”

Alan E. Jones, MD, FACEP, president-elect of the Society for Academic Emergency Medicine, says, “Boarding admitted patients in the emergency department is a dangerous practice that clearly affects the safety of patients, both boarded patients and new patients. A solution to this problem is past due and we remain hopeful that this new paper will urge administrators to enact meaningful changes.”