We are a stand-alone ED. This means there is no hospital attached to our facility so when patients need to be admitted, we have to transfer the patient from our ED to a hospital. If there are no available hospital beds at area hospitals, the patient boards in our department where we lack resources to provide adequate inpatient care.
We had a 92 y/o female board in our department for 117 hours. That's just about five days. She was being treated for a UTI, needed further evaluation for a possible GI bleed and was having frequent falls at home necessitating a physical therapy/occupational therapy (PT/OT) consult. Studies have shown that being bed-ridden in hospital stays can cause significant muscle atrophy. This was an unfortunate 92 year old already having problems getting around safely who we kept in an ER bed for five days. This was time she was not getting the PT/OT needed to get her stronger to safely get around at home and we were compounding the problem by having her in bed for 5 days contributing to muscle atrophy. Additionally, we don't have hospital quality beds that are made for prolonged stays. Because of this the patient developed a bed sore on her sacrum which could have been prevented had she been in a hospital.
This is not health care. This is a subpar way to keep people alive while simultaneously contributing to the detriment of their overall health.
Another egregious case we had was of a gentleman with a slow GI bleed. He needed to be hospitalized for endoscopy/colonoscopy but since there were no beds at the hospital he was in our department for 3 days. During this time we were able to transfuse blood products for him to get his blood counts back up to a healthy level. Unfortunately, because we weren't able to provide definitive care that he could get in a hospital, we watched as his blood counts slowly dropped down again to the point of needing another transfusion before we finally were able to get a hospital bed for him. Since we are surrounded by hospitals, we call each shift to check on the bed status at area hospitals. When we are boarding, none of the area hospitals accept patients so we just have to keep calling. You can see how these prolonged stays not only drain the resources of our small department, but also drain community resources (blood products, transfer center resources etc). Meanwhile our ability to see new patients is compromised because our beds and our staff are tied up doing our best to provide 'inpatient care' with our limited resources.
When people need to be hospitalized for an acute medical issue, their health suffers by languishing in Emergency departments. Imagine your family or loved one waiting in an Emergency Department for 5 days waiting to get to a hospital, or watching them have a slow bleed that is not being stopped and the best fix available for 3 days is to transfuse blood at a pace that keeps up with the bleeding. This is not health care. This is a subpar way to keep people alive while simultaneously contributing to the detriment of their overall health. Meanwhile this method of resource utilization draws from the community as a whole.