Improving the Problem of ED Boarding

According to previous research, boarding inpatients in EDs is one of the main drivers for crowding. In the August 2012 issue of Health Affairs, my colleagues and I explained what is known about the causes and dangerous effects of boarding, strategies that have been demonstrated to alleviate boarding but are underused, and possible regulatory steps that will be needed for hospital leaders to increase efforts to address boarding. Crowding & Boarding: A Costly Problem Inpatients who are boarded in EDs burden already busy ED staff and are kept in brightly lit, loud environments for many hours or even days. Not surprisingly, studies have shown that boarding increases morbidity and mortality, lengthens hospital stays and durations of intubation, worsens pain control, and compromises care. Patients may also have greater exposure to hospital-acquired infections. Boarding also affects measures to which hospitals are held accountable, including time to receipt of antibiotics for patients with pneumonia and the development of bedsores. Furthermore, long waits due to crowding cause some patients to leave EDs before being seen by physicians, robbing them of care and decreasing hospital revenue from their visit. [polldaddy poll=7044226] Boarding occurs when inpatient beds are not available to patients admitted through the ED. This sometimes is the result of hospitals being at full capacity, but inefficient operations may also be partly to blame. Even when hospitals are not at full capacity, hospital leaders who don’t fully understand the costs of boarding may preferentially reserve beds for patients whom they consider more profitable than ED patients (eg, elective surgery patients for whose care is assured reimbursement). Evidence is mixed on whether this...