Emergency Department Boarding Stories

I work in an ED in a very rural area. We are the only hospital in the county, which is three times the size of the state of Delaware. The resources in our hospital consist of a single coverage ED doctor, family medicine doctor(s), and OB coverage. We have no ICU coverage, surgical coverage, cardiology coverage, or any other specialists that can manage anything beyond the simplest admission (i.e., no intubated, BiPap, stroke patients, heart attacks). Our issue is not necessarily the boarding of patients in our own ED, but we, and our patients, suffer the effects of boarding in our transferring hospitals. As noted above, our hospital has very few resources and we must transfer any complex patient.

We have had numerous patients succumb to the effects of their traumatic wounds and illnesses due to the inability to timely transfer our patients.

During one of my 24-hour-shifts, I will routinely transfer more than three patients for an assortment if issues including, complex pneumonia, COVID, stroke, heart attacks, electrolyte disorders, kidney failure, orthopedic/trauma issues (i.e., hip fractures, spine injuries, etc). If the receiving hospitals are holding patients in their ED because their hospitals are full, our requests for transfer will be refused. We routinely have to reach out into [neighboring state], and cities as far away as [city] to find a bed for our patients. Unfortunately, we have had numerous patients succumb to the effects of their traumatic wounds and illnesses due to the inability to timely transfer our patients, secondary to the boarding at the receiving hospitals. Thank you for your assistance in addressing this critical issue.