Emergency Department Boarding Stories

"We are the level 1 trauma center for our area. We have approximately 90 beds in the ED and on this night we had 58 people in the waiting room and in our pod of the ED there were only three active beds (meaning beds not filled with admitted and boarding patients). Some of the boarding patients had been admitted to the hospital for 40 hours. One of them was an 80 yo man who was in a shared room being treated for a urinary tract infection. The ED is noisy and bright so it was not possible for him to get restful sleep. Because we had so few beds available to work with in our pod, I was seeing patients in ambulance triage (the area where patients who are brought in by EMS and are too sick to go to the public waiting room are kept).

Because we had so few beds available to work with in our pod, I was seeing patients in ambulance triage.

Because we had so few beds available to work with in our pod, I was seeing patients in ambulance triage This area is usually a mix of intoxicated patients or patients needing psychiatric evaluation and elderly people. I saw that someone had ordered protocoled imaging on an 81 yo female who fell while going down stairs at home and had a displace femoral neck fracture. By the time I saw her she had been there for six hours, stuck on a stretcher inches from an intoxicated man who was vomiting on himself and another patient screaming obscenities. She had not gotten any pain medication and was having severe right hip pain. She also had to urinate badly but had been unable to get anyone to help her.  There are two triage nurses who are there to watch the 15+people who were in ambulance triage that night while also receiving the new EMS patients. Orthopedic surgery saw my patient and admitted her from ambulance triage. For the rest of my eight hour shift she remained in ambulance triage waiting for a bed upstairs or to go to the or, whichever happened first. She is only one of many patients with broken bones that I have seen wait for hours before being seen because of how boarded our ED is.

We are in a crisis and although we do everything we can to MacGyver solutions to the problem while we are on shift, there is only so much we can do from the ground.

I have also seen a patient in severe DKA who had been in the waiting room for seven hours as well as countless other patients with significant disease who waited many hours for evaluation.  It is demoralizing to start every patient encounter with profuse apologies for the wait and difficulty they have had to endure just being in our emergency department.  It is heartbreaking to find someone who could be my grandmother languishing in pain for hours before we are finally able to see and evaluate her. We are in a crisis and although we do everything we can to MacGyver solutions to the problem while we are on shift, there is only so much we can do from the ground. We cannot fix this problem in the ED, we need help."