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ACEP Calls for Halt to ED Boarding

Cheryl Clark, for HealthLeaders Media, October 4, 2010

The practice of boarding prompts patients to leave the hospital without proper care, and hospital executives must set policies that hasten the flow of admitted patients from the emergency department to inpatient beds, a report from the American College of Emergency Physicians says.

Speaking at the ACEP annual meeting in Las Vegas last week, newly elected president Sandra Schneider, MD, said "It is more urgent than ever that we exert pressure on hospitals and policy makers to end the practice of boarding."  This is especially so, she said, because with the implementation of healthcare reform, emergency room visits are expected to increase.

Wait times in emergency departments are already surging.

"Boarding harms patients and ACEP is committed to ending this dangerous practice," Schneider said. "Hospital leaders must be involved to ensure that these patients, often the sickest in the hospital, get the attention and expertise they deserve."

Schneider said emergency departments triage patients to make sure the sickest patients get care first, but some very sick patients do not initially have symptoms of a medical emergency.  "If the gridlock in emergency departments could be reduced by increasing throughput (to an inpatient bed) patients would not leave without being seen, which can be dangerous, especially when millions more people are seeking emergency care every year," ACEP said in a statement.

"High rates of patients leaving without being treated are poor for patient safety," said lead author Jason Wilson, MD, of the University of South Florida in Tampa. "Our study affirms that long waiting room ties correlate with larger number of patients leaving prior to physician evaluation. And we know that long waiting times are directly connected to boarding in most hospitals."

Another study presented at the meeting showed that in hospitals with policies that speed flow within 30 minutes to internal medicine or general surgery beds, length of stay dramatically goes down.

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3 comments on "ACEP Calls for Halt to ED Boarding"


michele (7/20/2011 at 10:48 AM)
I agree with James. We got people coming in for pregnancy tests, for stubbed toes, for ear infections, seasonal allergies and that was just yesterday. In 12 hours I saw 3 patients who needed an emergency room the rest were clinic patients. The best is when the pt tries to do the right thing and the clinic or their PCP office sends them into the ED for "faster test results". Really it is out of control.

James (10/6/2010 at 3:52 PM)
I don't suppose any of these rocket scientists have determined that the reason people are leaving the ED without being seen is because their condition doesn't justify an ED visit. What nobody wants to address is the elephant in the room called EMTLA. Change that and then ED's can return to their primary role. Which is addressing emergencys instead of being a 24 hour walk in clinic.

bob (10/4/2010 at 10:25 AM)
Many years ago, we solved this problem at a large teaching hospital with a very high occupancy rate. We did an analysis of emergency department patients requiring admission, and worked out a system in the admissions office to control the number of admissions of non-urgent in-patients each day so that beds would be available for the emergency cases. We found that we could do this without having to keep beds open on very many days when the predicted number of emergency admissions was less than estimated. We overcame opposition to this innovation of some of the surgical staff by allowing each member of the medical staff to admit no more than three non-urgent cases annually without question. This made all the difference in cooperation from the medical staff! The limitation on the number of non-urgent cases led to a great deal of voluntary innovation in medical staff management of their non-urgent cases and operating room scheduling: much more attention to prompt discharge of their in-patients; greater use of our ambulatory surgical facility; even getting us involved in improving quality at the other hospitals they were using!