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Alarm Raised Over Patient Boarding in Emergency Departments

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The group representing emergency physicians and other healthcare organizations says emergency room boarding has reached “a breaking point”.

The American College of Emergency Physicians (ACEP) and 34 other health care organizations are urging the Biden administration to hold a summit to address crisis levels of patient boarding in emergency departments.

Emergency department boarding occurs when there is a shortage of inpatient beds for hospital admissions or there are no beds in external facilities such as psychiatric hospitals . The Mixed Commission recommended that boarding at the emergency room does not exceed four hours; however, it has become common to have an ER residency for days or weeks, according to CAPE.

In a letter sent to President Biden last week, CAPE and three dozen other health care organizations paint a grim picture of the ill effects of ER boarding.

“In recent months, hospital emergency departments (ERs) have been brought to breaking point. Not because of a new problem, but rather a decades-long unresolved problem known as patient “boarding”, where admitted patients are detained in the emergency room. While the causes of emergency room boarding are multifactorial, unprecedented and growing staffing shortages throughout the healthcare system have recently brought this problem to a head. a tipping point, further exacerbating stress and burnout resulting in the current exodus of excellent doctors, nurses and other healthcare professionals,” the letter reads.

The letter details five negative effects of ER boarding:

1. Harm to the patient: “There are lots of evidence that boarding harms patients and leads to worse outcomes, compromises patient privacy, increases medical errors, delays care, and increases mortality,” the letter states.

2. Provide care in waiting rooms: “Many emergency physicians who submitted stories reported daily resident counts approaching or even exceeding 100% of the total bed count in their emergency department, while the number of patients in the waiting room accounted for up to ‘to 20 times the number of free treatment beds they could even be seen in. In the past, that often left only hallway stretchers in the ER to deal with incoming patients. also are increasingly over capacity, and so the emergency department waiting room has become the last ad-hoc place to receive patient care,” the letter states.

3. Pediatric patients: “Unfortunately, the pediatric population is not immune to the severe emergency boarding problem we face, particularly those with mental health issues. Over the past decade, pediatric emergency room visits for mental health issues have increased dramatically.The COVID-19 pandemic has led to a greater acceleration of these visits, causing several pediatric health organizations to issue a national emergency for children’s mental health in 2021 and the Surgeon General of the United States to issue an advisory on mental health in young people.… Numerous studies show that pediatric patients with mental disorders who are institutionalized are more likely to leave untreated and less likely to receive counseling or psychiatric drugs,” the letter reads.

4. Psychiatric patients: “The boarding of psychiatric patients in emergency rooms is particularly prevalent, disproportionately affecting patients with behavioral health needs who wait an average of three times longer than medical patients due to significant gaps in our healthcare system. Although the ED is the frontline safety net, it is not ideal for the long-term treatment of mental and behavioral health needs. Research has shown that 75% of psychiatric ED patients, if they are quickly assessed and treated in an appropriate location, away from the busy and disruptive environment of the ER, see their symptoms subside to the point they can be discharged in less than 24 hours.However, far too many Americans have limited options for accessing outpatient mental health care,” the letter read.

5. Exhaustion of boarding readers: “Overcrowding and overcrowding in the emergency department is a significant and growing contributor to the burnout of doctors and nurses, as they have to watch patients unnecessarily decompensate or die despite their best efforts to keep up with the increasing flood of patients. more and more sick coming in. Health care professionals experiencing burnout have a much higher tendency to retire early or stop practicing altogether.This increases the loss of skilled health care professionals within of the workforce and adds more pressure to those who are still practicing, prolonging the cycle of burnout within the profession,” the letter said.

Related: Researcher: ‘Dykes have broken’ in emergency services

Christopher Cheney is the Clinical Care Editor at HealthLeaders.

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