Emergency Room Boarding

Topics: Hospital, Emergency department, Urgent care Pages: 7 (2062 words) Published: November 2, 2013
Running head: BOARDING PATIENTS IN THE EMERGENCY DEPARTMENT 1

Boarding Patients in the Emergency Department
Lauren Wiese
University of Scranton
BOARDING PATIENTS IN THE EMERGENCY DEPARTMENT 2
Abstract
A patient who is boarded is one who remains in the emergency department even after they have been admitted to the hospital. Boarding patients in the emergency department has become a problem for many hospitals in America today. It has affected the health and safety of patients and staff in numerous ways. This is an issue that needs to be resolved soon or the overall quality of healthcare in America will drop substantially. BOARDING PATIENTS IN THE EMERGENCY DEPARTMENT 3

Boarding Patients in the Emergency Department
A major issue affecting hospitals in the United States today is the process of boarding patients in the emergency department (ED). It is the primary cause of overcrowding in a hospital and affects more than 90% of hospitals in America (Lowes, 2001). The practice of boarding or “holding” patients endangers the safety of hospital staff and the patients themselves. It causes delays in care and even worse ambulance diversions. Emergency department visits climbed fourteen percent from 1992 to 1999 (Lowes, 2001). This shows that boarding patients is a risk to the incoming ED patients.

The nursing shortage in America is a direct contributor to the practice of holding patients in the ED. When there are beds available for patients in the hospital, there might not be personnel to staff them (Lowes, 2001). There have been instances where there were unoccupied inpatient beds but just no nurses to care for them. In some parts of the country, the scarcity of nurses has reached crisis proportions.

Another cause for the use of boarding patients is hospital downsizing, which instantly affects the amount of inpatient rooms. The latter part of the twentieth century experienced major hospital closings and ED closings. Hospitals were forced to close due to budget cuts or not enough staffing. When hospitals close, it causes overcrowding in the hospitals that stay open. Overcrowding causes longer waits and fewer beds, which in turn leads to boarding patients (Lowes, 2001, p. 81).

A hospital is a system with patients flowing through it, from admission through testing and treatment to discharge. Boarding results from backups in this flow. Inpatient beds are not readily available to patients admitted through the emergency department therefore they must be

BOARDING PATIENTS IN THE EMERGENCY DEPARTMENT 4
retained in the halls of the ED. Backups in the Emergency Department have been occurring in America for the past decade. (Pines,2006).
There are no positive aspects to this issue, but the negative aspects of this issue are very detrimental to the health care system in our country. When a patient enters a hospital and expects care right away, they do not want to be waiting around in a bed in the hall of an emergency department. Waiting a few minutes is okay but once it starts to be hours, people can get unruly. Patient satisfactory plummets when they are put in that situation. The Centers for Disease Control (CDC) found for patients judged to be in critical condition, more than ten percent waited more than one hour to see a physician in the ED. This is a dangerous drawback because most illnesses are time dependent so waiting longer to seek care could be harmful to the person’s health (Pines, 2006).

Studies have shown that overcrowding indirectly increases medical errors. “Many of these errors are of omission and not commission since the emergency staff must simultaneously care for inpatients and focus on the new emergencies coming in the door,” says Cowan (2005) (p. 291). The law requires on-call doctors to respond to emergencies immediately or receive a fine of up to $50,000 (Lowes, 2011, p.71). If doctors and nurses are tending to multiple patients at a time and...

References: Cowan, R.M. (2005). Clinical Review: Emergency department overcrowding and the potential impact on the critically ill. Crit Care; 9(3), 291-295.
Derlet, R.W. (1995). Prospective identification and triage of nonemergency patients out of an emergency department: A 5-year study. Annals of Emerg Med; 25:215-223.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672221/pdf/wjem-9- 0024.pdf
Krochmal, P. (1994). Increased health care costs associated with ED overcrowding. Am J Emerg Med; 12(3), 265-266.
Lowes, R. (2001). What will it take to solve the ER crisis? Medical Economics, 78(23), 70-2, 77, 81. Retrieved from http://search.proquest.com/docview/227782380?accountid=28588
Pines J.M. (2006). The association between emergency department crowding and hospital performance. Acad Emerg Med; 13(8), 873-878.
Richardson, D.B. (2006). Increase in patient mortality at 10 days associated with ED overcrowding. Med J Aust; 184(5), 213-216.
Schull, M.J. (2003). Emergency department contributors to ambulance diversion: a quantitative analysis. Annals of Emerg Med. 41(4), 467-476.
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