ED Boarding Has A Solution, Why Haven't Hospitals Implemented It?

                                                          By Ashleigh Hollowell

Emergency department boarding has a solution, but hospitals aren't implementing it, according to Hashem Zikry, MD, a current emergency medicine physician at UCLA, and former chief resident in the emergency department at Mount Sinai Hospital in New York.

In a Feb. 28 opinion piece, Dr. Zikry argues that sometimes hospitals can get caught up in prioritizing patients for certain surgeries that pay the hospital more than basic care for someone who is sick, but this further contributes to boarding by not always prioritizing the more sick patient. He said he has witnessed some patients wait days for basic care due to capacity strains, all while gradually getting worse and feeling more sick.

COVID-19's toll on hospitals, emergency departments and clinicians has been widely documented in healthcare since 2020, but Dr. Zikry says "less has been written, however, about the side effects of hospitals' attempts to recover from that era — one of the most serious of which is the proliferation of boarding," he writes. "As hospitals scramble to regain their footing (and their profit margins), the financial incentive structure that undergirds U.S. medicine has gone into overdrive. Inpatient beds that might previously have been reserved for patients … who require essential care but generate very little money for the hospital, are increasingly allocated for patients undergoing more lucrative procedures."

Continuing to follow the more lucrative path will fail patients, and already is, Dr. Zikry explained, particularly pointing to The Joint Commission's standard that says patients should be waiting no longer than four hours at a time to get necessary care.

"Many narratives around boarding focus on the patients themselves, shaming some for inappropriately using the emergency department. Proposed solutions include pushing patients to urgent-care centers or modifying 'patient flow.' But the issues with boarding cannot be addressed with such minor tweaks," Dr. Zikry wrote.

The solution is maintaining a data-driven hospital system and emergency department, he suggests.

"The solution is actually clear: use data from past years to predict future admission needs and then save that number of beds on inpatient floors," Dr. Zikry wrote. "Studies have shown this is feasible, and it has already been successfully implemented in a handful of health systems."

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