Solutions to ER Crowding Are “Grossly Underused”

Boarding in emergency departments, which is at the root of crowding and potentially dangerous wait times, could be virtually eliminated by implementing a number of strategies proven to improve efficiency, but federal regulation may be required to bring those strategies into widespread use. A policy analysis published recently in Health Affairs notes that these strategies are widely underused. (“Solutions to Emergency Department ‘Boarding’ and Overcrowding Are Underused And May Need To Be Legislated”).

“This paper is another in a long series of wake-up calls about the dangerous practice of ‘boarding’ admitted patients in ERs,” said the president of the American College of Emergency Physicians, David Seaberg, MD, FACEP. “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.”

Authors reaffirmed ‘boarding,’ the practice of holding admitted patients in the emergency department, as the cause of emergency department crowding and long wait times, and called it “a symptom of dysfunction in interrelated parts of the broader health care system.” Boarding has long been associated with worse health outcomes, longer hospital stays and mortality, but hospitals often board admitted emergency patients because they tend to be less profitable than patients admitted for elective surgeries, such as knee replacements.

Strategies that have been shown to be effective in reducing boarding and crowding include moving admitted patients to in-patient hallways, smoothing elective surgical schedules and active bed management. Authors cite evidence demonstrating poor penetration of these strategies among hospitals.

Researchers go on to recommend that hospital leaders and the public be engaged to address the problem of boarding and suggest that the Centers for Medicare and Medicaid (CMS) could “increase incentives for improvements in patient flow.”

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

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.