21
votes
Boarding patients in the emergency department while they wait for available beds is a significant problem that increases avoidable US deaths
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- Title
- Emergency rooms are not okay
- Authors
- Kristen Panthagani, MD, PhD
- Word count
- 1038 words
Yep, my wife works in the emergency department of a level 1 trauma center and this is a common issue. It's a big reason why they have people who sit in the waiting room for 20+ hours. Sometimes they'll only have a couple of beds with people who are or will be eligible for discharge as opposed to the rest who are waiting for admissions to another unit.
There is an irony in my partner's medical care now being so default critical that he hasn't been a boarder in the past year. He rarely waits in the ER and the only issue we have is that if they want him in a bed the only rooms with hoyer lifts are their large trauma/procedure rooms.
But we had a bad ice day and he was at the ER at 7:30am for unrelated reasons, by 9am I was passing through and they'd just had 5 or 6 ambulances back to back for falls, head injuries, car accidents, and the like, on top of people coming in the main ER entrance, and a half dozen patients were now boarded in the hallway. Idk if they were true boarders or just overflow treatment but it was not great. And it's hard to be in the hospital, in pain, and in public at the same time even if nothing else is critical.
So, not a medical professional, but is the issue "Our standards for patient rooms are too high and therefore we've got too many 'big' rooms and not enough patient rooms" or is the issue just "too many people being consolidated on too few major medical sites"?
I mean, I've been in a level 1 center recently and the room was pretty cush but I'm sure it's a lot smaller if they need to provide more intensive care but I've also seen some hospitals with barely a sheet between beds... So, I guess I don't know the answer? More medium sized hospitals so everyone doesn't get funneled to the bigger ones?
"Beds" is the constraint, but it isn't really the issue.
The problem is that the facilities are designed and staffed to handle certain quantities of patients. Those quantities are roughly represented by "beds." But if you added a third bed to every single semi-private room you still wouldn't have the staff to be able to fill them.
Covid was really hard on our healthcare workers; a lot of them have retired, burned out, cut back, or switched to other less stressful fields. And it's not like we had a surplus of doctors and nurses to start with. And we're just starting the boomer demographic crunch, for which our healthcare systems are woefully unprepared. And healthcare is notoriously bureaucratic, so there are tons of legacy inefficiencies. And healthcare reform is such a political hot potato that our politicians aren't going to touch it until the system completely breaks because only then will the public be convinced of the sort of reforms which are necessary.
I think the article lays out a number of reasons, but I think staffing is really key, especially post pandemic. So many hospitals are short staffed, nurses are underpaid, travel nurses make more money and fill in the gaps, but no one wants to sign a higher contract.
And also a lot of medical professionals were burnt out during COVID-19, especially with the increases in violence and harassment. One of the smaller local hospitals that I've been too far too often currently has an entire floor that's empty. Surgery is on that floor but the rooms used to be regular hospital rooms or pre and post-op rooms. I haven't seen anyone in any of those rooms for over a year when we've been through.
The physical space does not seem to be the issue most of the time.
"Bed" is an abstraction. It doesn't mean the physical piece of furniture someone lies on; a "bed" in a hospital is the resources required to house and care for a single patient. That does include the furniture, obviously, as well as the space to put it, but also includes staffing (both nursing, physicians, and support staff), infrastructure, even stuff as abstract as food service capacity. The limiting factor in most hospitals these days is staffing (since inpatient medicine has become incredibly unpleasant during and since the pandemic).
Some of the issue relates to the availability of beds outside of the hospital. It might be appropriate to transfer the patient to a long term care facility for rehabilitation, but if those facilities don't have beds, the hospital isn't free to simply put the patient out onto the street. Likewise if someone arrives at the emergency department in a mental health crisis, it might take time and effort to find a spot for them in a psychiatric hospital.
Also very true. Nursing homes as well. Where I've recently learned* basic staffing safety protocols aren't even being followed. (Non-CNA was being told to do what should have been a two CNA job using a hoyer lift and a patient was dropped/fell)
*I know this isn't unique or new, but it was a recent personal story told to me. I'd cut my arm off to keep my partner out of a nursing home right now.