"There is a large healthcare system that has created a complete monopoly on accepting transfers from the multiple rural hospitals surrounding the city. The Outreach personnel provides administrative and educational support to the rural hospitals creating a "partnership". This results in these small, privately or community-owned facilities adding the large, well-known hospital system's logo next to its own. All signs and materials contain both logos with "In Partnership With" between them. The public then immediately thinks that the small hospital is a satellite facility for the larger, urban system. In exchange for this perception, the urban hospital incorporates a quick, seamless transfer process for patients needing a higher level of care and will accept ALL transfers from the rural hospital 99% of the time. How this relates to boarding is that patients will be accepted whether there is an available bed or not.
Physicians are reluctant to push back on the hospital's desire to capture all of the rural transfers and create a significant boarding issue due to not wanting to "make waves"...
Many times patient discharges are anticipated later in the day; however, the bed is currently occupied. Even if a discharge is not planned, patients will still be accepted with the thought that discharges will ultimately occur at some point. Patients that are transferred into one of the many hospitals owned by this large system are then sent to the Emergency Department. The Emergency Physicians, therefore, have fewer beds in which to see their own, continually arriving, Emergency patients. These doctors are Independent Contractors working with a major physician staffing contract group. The contract group contracts with the hospital to provide Emergency Physicians to staff their EDs. These physicians are reluctant to push back on the hospital's desire to capture all of the rural transfers and create a significant boarding issue due to not wanting to "make waves" and upset hospital administrators who will then look to replace the Physica Staffing Contract Group.
Studies have shown that patients boarded in Emergency Departments have worse outcomes than patients who are directly admitted to an inpatient bed.
So newly-arriving patients to their ED have their care delayed, patients transferred from a rural hospital will be boarded in a busy, crowded, noisy Emergency Department and are being cared for by Emergency Nurses who have little training in the care of admitted patients. This also detracts from the time that Emergency Nurses can provide to actual Emergency Department patients. Studies have shown that patients boarded in Emergency Departments have worse outcomes than patients who are directly admitted to an inpatient bed. The current lack of quality Emergency Nurses also adds to making this situation worse.
In summary, this large healthcare system is creating its own boarding issues in order to increase the number of patients that it can process through its hospitals. This practice negatively affects nurses, doctors, and most importantly, patients."