Emergency Department Boarding Stories

"My shop is a 34 bed rural tertiary care center that serves an area greater than 20,000 square miles. Month after month our boarding issues continue to exacerbate and have surpassed critical levels many months ago.  We are frequently the largest in-patient ward in the hospital. We have a NEDOCS* > 200 (Dangerously Overcrowded)  since June. Currently we average 28 boarding patients in our department and this has been as high as 41 boarded inpatients and 31 patients in the WR less than a week ago. It is not unusual for boarded patients to exceed 100 hours and we now routinely discharge in-patients from the ED who never move to an “in-patient bed.” Due to these challenges we have fully implemented “waiting room medicine,” closed down our Provider in Triage,  instead all providers pickup patients in the Waiting Room. Nearly 50% of our patient encounters now result in discharge from the waiting room.  Finally, it is not at all uncommon to have patients in the waiting room with SarsCoV-2, pending orders for heparin, diltiazem, or other vasoactive medications. In the past month we have had SAH, Fournier gangrene, Hip fractures, Septic shock all being treated in the WR with no available beds to move them into."

*[NEDOCS= National Emergency Department Overcrowding Scale]