A number of factors contribute to gridlock in the emergency department, but the practice of "boarding," or leaving, admitted patients for extended stays in the emergency department until hospital inpatient beds become available — the primary cause of emergency department overcrowding. Boarding is a patient safety and quality concern, because these patients require additional equipment and staff time, further shrinking already limited resources needed to treat other patients.
Emergency department visits in 2006 rose to 119.2 million, up from 90.3 million in 1995 — a 32 percent increase. At the same time, the number of emergency departments decreased by 9 percent resulting in dramatic increases in patient volumes and waiting times at the remaining facilities. The majority of the nation’s hospital emergency departments report that they continue to operate at or over critical capacity. Half a million ambulances are diverted from hospitals every year — one a minute, according to the Institute of Medicine.
To compensate for cutbacks in reimbursement from Medicare, Medicaid and private insurers, hospitals closed 198,000 staffed beds between 1993 and 2003. As a result, fewer beds are available to accommodate admissions from the emergency department. Emergency department boarding is further worsened by competition between emergency department admissions and scheduled admissions, such as elective-surgery patients.
The overall result is that critically ill or injured patients may have extended stays in the emergency department and may have to be treated in whatever space is available, including offices, storerooms, conference rooms and even hallways.
The collection of emergency department boarding data is essential to understanding how boarding affects patient care and safety. For this reason, hospitals should report data on emergency department boarding to CMS, and where appropriate, standards and guidelines should be developed to alleviate this problem.