Solutions To Emergency Department ‘Boarding’ And Crowding Are Underused And May Need To Be Legislated

Abstract

The practice of keeping admitted patients on stretchers in hospital emergency department hallways for hours or days, called "boarding," causes emergency department crowding and can be harmful to patients. Boarding increases patients' morbidity, lengths of hospital stay, and mortality. Strategies that optimize bed management reduce boarding by improving the efficiency of hospital patient flow, but these strategies are grossly underused. Convincing hospital leaders of the value of such solutions, and educating patients to advocate for such changes, may promote improvements. If these strategies do not work, legislation may be required to effect meaningful change.

Better performance on length-of-stay benchmarks associated with reduced risk following emergency department discharge: an observational cohort study

“…Better management of EDs likely requires the routine measurement of ED LOS and wait times, but the experience of jurisdictions that have improved performance suggests that setting benchmarks and performance targets for ED wait times is also important to help galvanize improvement efforts. 44 Results here suggest that better performance on ED wait time benchmarks is associated with substantial improvements in patient outcomes and supports current recommendations from the Canadian Association of Emergency Physicians. 12 This is an important consideration for policymakers in other jurisdictions and health systems who are aiming to reduce ED crowding and improve patient outcomes.…”

“…43 Jurisdictions also vary in the performance target that they set for achieving their time benchmarks, varying from 75%-98%. 15,16,43 In the United States, some observers have suggested a similar approach, 44 but the Centers for Medicare and Medicaid Services asks only hospitals to report ED LOS, whereas the Joint Commission has issued a hospital-wide patient flow standard without any benchmarks. 45 …”

Overcrowding in emergency department: an international issue

“…In addition to the target time and full capacity protocol, there are several procedures that are able to improve patient flow. But the bottlenecks are not always in the hospital: if the primary care and post-acute care (post-acute beds, aged care beds, rehabilitation beds, nursing home care), does not work well, we can hardly deal with the overcrowding [36].…”

Remodelling Ofhospital Equipment- Incorporating Experience to Address Patient Comfort and Safety.

“…This exercise is defined as boarding 1 and may lead to increased morbidity and mortality with increased length of stayand the patient supported on stretcher may be at a higher risk of pressure and necrosis 2 . However, it is resorted to, due to overcrowding in emergency departments and consequently lack of beds,predominantly in public sector hospital.…”