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.
At Albany Medical College in New York, the length of stay dropped in half, said Daniel Pauze, MD. "It shows that we can get patients out of the ER and into inpatient beds if hospital leadership demands it. It's good for both patient safety and the hospital's bottom line when you stop people walking out the door without treatment."
Door-to-balloon times for heart attack patients also improved, another study showed, when the frequency of hospital boarding is reported to a hospital's governing boards. That's significant in light of a Health Affairs report in 2008 showing that wait times for heart attack patients increased by 150% from 1997 to 2004, and that 25% of heart attack patients waited nearly an hour before seeing a doctor.
Emergency room visits in the U.S. increased to nearly 124 million in 2008, up from nearly 117 million in 2007, according to the Centers for Disease Control and Prevention.
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