Emergency Department Boarding Stories

"I work in an emergency department in a suburban setting. Our facility has such a shortage of nursing on the floor that we routinely board seven to 30 admitted patients in the ED nightly. Patients spill out to all the hallways. There is no privacy. We give blood transfusions in the hallway, have stroke evaluations in the hallway, and patients hate it. The people in the hallways are sometime the fortunate ones because the other patients are in the waiting room hoping to being seen sometime.

I arrive to my shift with usually 15-20 people waiting between one to eight hours in the waiting room to be seen. Of course people with critical abnormal vitals or appear about to code are rushed back to be seen. We shift people to more hallways to make room for the critical. The rest of the patients wait and have their treatment in the waiting room. We have opened a split flow and vertical care area to get straightforward possibly dischargeable patients seen and discharged. This is the only solution corporate has devised to have some flow. The complicated, older, multiple medical problems and potentially needing admission patients remaining waiting in the waiting room.

Doctors, PAs, NPs, and nurses cannot do our jobs to the standards we routinely followed two years ago.

Does that make sense?  Doctors interview patients in the waiting room or triage rooms and order tests that the triage nurses do their best to accomplish. The patients that are moderately ill who would benefit from timely ED interventions cannot get their care. In the past it was unacceptable for a 70 year old with chest pain or a 56 year old sent by PCP for anemia requiring blood transfusion to wait for five hours and have their care in the waiting room until they are admitted but now it is the standard. Those are examples of my patients from last night, and it has happened every night I worked this month. I have so many examples of ill patients equally disturbing.

Do we want this to be our new standard? Doctors, PAs, NPs, and nurses cannot do our jobs to the standards we routinely followed two years ago. This is making our current workforce providing direct patient care very depressed and wondering how long we can continue. Administrators and hospital managers do not work in this crisis environment daily so are comfortable with this standard -hoping that it will just improve with time. Administration do not need to see and talk with these sick, waiting patients so perhaps are less disturbed. This is a crisis."