Emergency Department Boarding Stories

"We see almost 90k annual visits in our ED. On a daily basis we are challenged with 1/3-1/2 of our beds occupied with boarders. While previously we were able to adapt, utilizing float pool to care for these patients and creating “care spaces” in every nook and cranny, the current boarding and staffing crisis leaves us at the breaking point. ED nurses, with less than 50% staffing sometimes at night, are left to care for boarders in the ED as well as acute patients. 

The current boarding and staffing crisis leaves us at the breaking point. 

Inpatients rooms are closed due to staffing with ratios upstairs barely budging from 1:4. We’ve had lobby nurses responsible for 15-20 patients.  We’ve pushed diltiazem, hung amiodarone, cared for septic shock, and are now admitting patients regularly directly from the lobby.  Care is being provided in chairs with little privacy and the hope of a portable monitor.  Meanwhile 40 boarders are being cared for in an ED with overhead pages, lights on all the time and a total of 5 bathrooms and no showers. One night we had a septic patient waiting two hours for triage code and die in our triage room. It frustrates me that legislators, administrators and regulatory bodies are so disconnected. We’ve had two large surveys in the last month, and they couldn’t see the forest for the trees.  One agency cited us for using hallway beds, the other for NOT then using hallway beds and providing care in the lobby.  We are “complianced” to death while CEOs collect large salaries and ED physicians and nurses are crying at the end of every shift.

One night we had a septic patient waiting two hours for triage code and die in our triage room. 

During a recent AMA medical staff wellness survey 50% of our medical staff indicated they were planning to leave medicine in the next two years.  If you think the mass resignation left our country high and dry, wait until you see what the mass exodus of physicians does to our country.  There needs to be immediate and patient-focused action to ensure that the United States hospitals are able to provide quality care to everyone.  The squeeze from insurance denials, balance billing, staffing and supply chain is destroying health care in America  I guarantee without rapid change, the only winners in the near future will be insurance and pharmaceuticals. I promise it will not be physicians and will definitely not be patients. Thank you for this opportunity to try and paint the picture of the grave state of acute health care in the U. S."