When EDs keep elderly patients for long periods after they've been admitted until a bed opens up, it contributes to delirium. "The patients can get confused and disoriented," she said. "And then everybody says, 'Oh my God, they have to go to a nursing home.' "
There's evidence, Schneider says, that these elderly patients are three-to-four times more likely to have to go to a nursing home rather than home after discharge than if they had taken directly to a bed.
"It doesn't matter how sick they are; that's just the difference between what happens on crowded ED days versus not-crowded days." Schneider says the U.S. could learn from England, Canada, and Australia, all of whom have put time limits on how much time people can spend in the ED.
The idea of time limits took hold in England after an elderly woman spent two days in the ED waiting for a bed, Schneider explains. "It was so horrifying to the British public that there was an outcry to impose time limits," she added.
"What was amazing to us in the U.S. is that almost every one of us knows patients who have spent two days; that's nothing," she said. An ACEP study soon to be published will show patients spending four and five days waiting in the ED for a bed, and one in Massachusetts that is looking at patients with mental illness spending as many as eight days waiting for an inpatient bed."
I thought the interview was about wrapped up. But Schneider asked to make another point. ACEP did a survey of ED directors in New York State several years ago. Asked if they personally knew of a patient that had been harmed because of ED boarding and overcrowding, 70% answered yes. Then they were asked if they had personally cared for a patient who died as a direct result of boarding and overcrowding...
"And 30% of these ED directors across the state of New York answered, yes.
"I think that's stunning," Schneider said.