Emergency Department Boarding Stories

"We are a 65 bed peds and adult urban ED, with a baseline of 10-20 boarders in the ED at all times. Our census is consistently 100-120 at higher volume times. Extremes have reached up to 170. We also have baseline staffing shortages, with an average BASELINE nursing ratio of ten:one. I review deaths and morbidities, as well as some performance measures, for the department over the past several years. Our performance is piss poor at baseline, and dangerous when at extremes. I am PGY 18, and have come to the conclusion over time that these issues are near universal in urban ED's, and likely similar in other "healthcare deserts," and the solutions are complex.

We have had many instances of patient death and poor outcome that in my opinion are directly related to boarding, and subsequently staffing levels.

In the past year, we have had many instances of patient death and poor outcome that in my opinion are directly related to boarding, and subsequently staffing levels. Unfortunately, proving that a systematic issue exists to our administrators is very difficult as each reported case is addressed individually. It is the heroic efforts of the staff we have and the ceaseless dedication and commitment that is preventing more deaths and poor outcomes than otherwise would be present. If we did not regularly stay after shift, and perform at a level that is two to three times that is reasonable for any one provider or nurse, our outcomes would be on the news regularly."