Emergency Department Boarding Stories

"I work in a busy urban emergency department. Our emergency department has approximately 45 official beds, but never has fewer than 100 patients - presently, we have 137 patients in our department. The effects have been catastrophic. It is almost impossible to get a room for anyone who is not actively dying. We routinely resuscitate patients in shock in hallway chairs without monitors. The patients overflow into not just the emergency department hallways but the hospital atrium and the radiology hallways. For the past year we cared for patients in a pop-up FEMA-style tent in the parking lot, including patients with heart attacks, strokes, overdoses, sepsis, and trauma. Patients routinely board in the hallways for their entire hospital course.

Staff morale has never been so low, and we lose nurses, physicians, and techs unwilling to tolerate the abysmal environment, making the situation worse.

The consequences to care are horrendous. I have had patients die in the hallway because they were unmonitored and there was no space to put them on a monitor. It is now standard to wait hours to see a nurse and be unable to urinate or get food. Staff morale has never been so low, and we lose nurses, physicians, and techs unwilling to tolerate the abysmal environment, making the situation worse. The quality of emergency care due to boarding has been nearly apocalyptic. I cannot explain how awful it is to have a patient die unmonitored of a preventable death because there are so many patients boarding that we cannot room patients for acute emergencies.

This problem must be solved for emergency medicine, and medicine in general, to be able to care for our communities. We need our emergency departments back and dedicated to caring for emergency patients, and for our inpatients ready for discharge to be able to go to safe, affordable, rehabilitation and other outpatient facilities. If this is not solved, the consequences will continue to be dire."