Emergency Department Boarding Stories

"We have ~70 beds, this AM we had 42 admitted patients (admitted up to 38 hours earlier), 10 boarding Behavioral Health Patients, and five social boarders/group home patients. Our group home patients all have chronic, lifelong behavioral issues, and were inappropriately 'dumped' in ED by the group home and guardian (whether LME or DSS, after not following state guidelines related to appropriate group home discharge). Our group home patients have been here from 1200 - 3520 hours. Considering average ED visit being three to four hours, those six group home patients boarding hours = loss of ability to see upwards of 2500 other ED patients. Collectively, these boarding levels (and resultant loss of capacity) have resulting in excessive wait times for patients of upwards of 18 hours for ED treatment room.

The situation for patients, families, and care team is untenable, and on the verge of collapsing.

In addition, frustrated with waits, depending on the day, up to 20% of patients are leaving before treatment complete. Our health system, and many others, are not resourcing their EDs for boarding hours of care and ED volume of visits (they are just resourcing for ED volume of visits). When ED boarding represented 5-10% of ED capacity, this was not ideal but manageable. Now that ED boarding is consistently 30-50% of ED capacity, and some days up to 90% of ED capacity, the situation for patients, families, and care team is untenable, and on the verge of collapsing (and trajectory of issue over the past several years is much, much worse).  

On top of that, it seems a higher percentage of Americans (again Baby Boomers, etc.) have not saved enough for grand old age, and American culture appears such that families are not wanting or able to support aging relatives - if unchecked, above issues will cause the system to collapse in not too distant future.  

P.S. This can't be blamed on COVID."