Written by Sadaf Qadir
Anyone who has stepped into an Emergency Room (ER) is well aware of the crowded environment and lengthy wait times. As a matter of fact, the National Center for Health Statistics (NCHS) found that emergency department visits had increased 32% from 1999 through 2009 [1]. Additionally, wait times had increased 25% between 2003-2009 [1]. While it can simply be annoying to wait in a crowded ER, there are also harmful implications for patient care itself.
To really understand why this problem occurs, it is first important to understand some common emergency room terminology such as overcrowding and boarding. Overcrowding is defined, not just as crowded ER conditions, but also as not having enough resources to meet patient demands [1]. As is, there is a lower quality of care for patients [1]. Overcrowding, both in the ER and in the actual hospital itself, can lead to boarding. Boarding occurs when patients are waiting to be transferred from the ER but have not been transported yet [1]. Boarding specifically refers to the act of keeping patients in the ER while they wait for a bed in the hospital or to be transported elsewhere [1]. Understanding these terms is important in beginning the discussion on ER crowding.
As implied by the terminology, overcrowding and boarding are factors that can lead to reduced health care quality in the ER. Indeed when patient mortality and revisits were measured, it was found that overcrowding does decrease the quality of patient care [2]. As previously mentioned, overcrowding can lead to boarding. Similar to overcrowding, boarding also increase the risk of patient mortality and increases length of hospital stay and costs [3]. Researchers have found that this averages to about 300 inpatient deaths, 6,200 excess days in hospital stay, and $17 million additional costs [4].
So why is boarding still a problem? Some of the reasons involve systematic delays, perception of where ER boarded patients should remain (the consensus is that patients should remain in the ER instead of on inpatient floors), revenue, and hospital organization [3]. However, many healthcare professionals and public health members do not find these reasons strong enough to continue boarding patients. Instead, they are trying to find determine the right solutions to implement and reduce this problem. One of their suggestions includes increasing hospital capacity, whether through by either opening new units or finding more staffing [5]. Another suggestion that is less costly and backed by many researchers is boarding patients on inpatient levels [5]. Other suggestions also consider the overuse CT scans (which increases the length of stay), finding primary care facilities for uninsured patients, and focus on disease prevention [6].
While these solutions are available changes will be slow to implement because this is an institutional problem. However, it is clear to see that a majority is in favor of reducing patient boarding and overcrowding.
References:
1) Hing E, Bhuiya F. Wait time for treatment in hospital emergency departments: 2009. NCHS data brief, no 102. Hyattsville, MD: National Center for Health Statistics. 2012.
2) Miró C, Antonio MT, Jiménez S, Dios AD, et al.. 1999. Decreased health care quality associated with emergency department overcrowding. European Journal of Emergency Medicine 6: 105–7.
3) 2014. What’s It Going to Take to Stop ED Boarding? Emergency Physicians Monthly
4) Sun BC, Hsia RY, Weiss RE, Zingmond D, et al.. 2013. Effect of Emergency Department Crowding on Outcomes of Admitted Patients. Annals of Emergency Medicine 61
5) Forman H. 2017. Why Hospitals Need to Stop Boarding Patients in Emergency Rooms. The Wall Street Journal
6) Derlet RW, Richards JR. 2008. Ten Solutions for Emergency Department Crowding. Western Journal of Emergency Medicine