The story of hospital emergency departments crammed with sick patients awaiting care, sometimes for days, could be written in almost any community around the country. It’s even worse in Syracuse, with patients waiting three times longer than the national average.
Staff writer James T. Mulder’s story “Syracuse emergency rooms are jammed, dirty and frustrating; waits are among worst in U.S.” (Feb. 27, 2023) brings this invisible crisis out into the open, with the help of dozens of Syracuse.com readers who shared their experiences of “boarding” at Syracuse-area ERs.
Boarding is when patients are parked in the emergency department while waiting to be admitted to the hospital for more treatment.
The post-pandemic shortage of nurses and other hospital workers means there are fewer staffed beds in hospitals. Patients awaiting admission to a long-term care facility also occupy beds. Add this winter’s “tripledemic” of Covid-19, influenza and RSV to the mix, and you have the nightmare scenarios patients described to Mulder of filthy conditions and long waits:
- a 67-year-old man with chest pain who waited 12 hours before being treated, even though he’d recently had a heart attack;
- a man with a broken leg who had to urinate into a plastic bottle while waiting for 24 hours on a gurney in a hallway;
- a man with possible appendicitis who waited 16 hours to be seen;
And those were the patients who stuck around. At Upstate University Hospital, 16% of emergency patients left without getting care. That number was 5% at St. Joseph’s Health and less than 1% at Crouse.
“Those numbers are horrific,” said Dr. William Paolo, Upstate’s head of emergency medicine. “They indicate the emergency department system is failing to be available for the people that need it.”
A common fallacy is that ERs are clogged with people who have minor ailments or who don’t have a doctor of their own. While that probably happens sometimes, the people who are being boarded for long periods in hallways and waiting rooms are sick enough to need more treatment in other parts of the hospital.
Boarding is not a new phenomenon.
For decades — yes, you read that right — emergency physicians have been sounding the alarm about the logjam in hospital emergency departments. Patients who wait a long time for care can have worse health outcomes; some even die.
The dire consequences of delayed care also inflict a moral injury on the healthcare providers in emergency rooms, who are doing the best they can under extremely difficult circumstances.
A 2021 New England Journal of Medicine commentary called ER overcrowding “the canary in the healthcare system,” indicating that it is failing. The authors blamed “misaligned healthcare economics” that pressure hospitals to fill beds with more profitable patients having elective surgeries. The solution, they wrote, is to fix the way hospitals are financed so that they can set aside enough beds for patients who show up in the emergency room.
Easier said than done, obviously. If this problem were easy to fix, it would be solved by now. Hospital finances are shaped by federal and state government funding and regulations, the government insurance programs Medicare and Medicaid, and private insurers. The capital and human costs of the pandemic made hospital finances even more precarious.
Onondaga Community College’s $32 million plan to expand training programs for nurses, technicians and other healthcare workers is a positive development. Gov. Kathy Hochul’s proposed budget includes $4 billion over the next decade to support wages and bonuses for healthcare workers. She also renewed the healthcare staffing state of emergency that suspends some rules to expand the pool of healthcare workers.
But clearly, hospitals need a national solution.
The American College of Emergency Physicians, in a November 2022 letter to the White House, called on President Joe Biden to convene a national summit on the crisis of patient boarding in the ER. ACEP wrote:
“Boarding has become its own public health emergency. Our nation’s safety net is on the verge of breaking beyond repair; EDs are gridlocked and overwhelmed with patients waiting – waiting to be seen; waiting for admission to an inpatient bed in the hospital; waiting to be transferred to psychiatric, skilled nursing, or other specialized facilities; or, waiting simply to return to their nursing home. And this breaking point is entirely outside the control of the highly skilled emergency physicians, nurses, and other ED staff doing their best to keep everyone attended to and alive.”
The president, Congress and the healthcare industry can’t look away from the emergency room boarding crisis any longer. Patients’ lives depend on it — and so does the wellbeing of our healthcare providers.
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