"While boarding issue was much more obvious at the urban tertiary hospital in [city] much more than us, we bore the brunt of their boarding issue in a different way as well. When their hospitals are full and are boarding patients in the ED, they often put their ED on “divert”, meaning not accepting ambulance or transfers. We’ve had countless patients who have complex surgical problems such as a complex fracture, vessel occlusion, burn, severe trauma, or complex medical problem such as bile duct blockages needing ERCP, or transplanted organ dysfunction.
These typically wouldn’t be a problem if the urban centers aren’t so full and boarding their patients all the time.
These patients needed to be transferred and taken care of in the urban tertiary care center, because our small community hospital simply isn’t equipped with the appropriate resources to care for them. However, when they are boarding and putting their ED on diversion, ED transfer is often not an option, at best, they would make the patient wait in our hospitals until a bed opens up at their hospital, which can take up to many days, days that many patients do not have due to the severity of their illness, some of them “crash and burn” at our hospital while waiting for a bed, for a problem that immediate transfers should be arranged. And these typically wouldn’t be a problem if the urban centers aren’t so full and boarding their patients all the time, at least, it was much less a problem before Covid exploded the system."