From the Editor: the Boarding Crisis

Honestly, I’ve never seen it this bad in my many years of practice. On my last shift, I walked into an emergency department where 36 of the 38 open patient rooms were occupied by inpatient borders—people who were already admitted to the hospital, some for nearly three days, but waiting for a bed upstairs. Several months ago, 20 newly renovated emergency department beds were co-opted by the inpatient services for boarders. More recently, another 20 beds went offline and have been converted into additional waiting room spaces while the main waiting room get renovated. All in all, in an emergency department with approximately 80 beds, we were holding 75 admissions.

According to a nurse who has worked in this department long before I have, this was a record number of boarders. But this one boarding story isn’t a outlier. My story is one of hundreds of boarding stories emergency physicians can tell about the dangerous, inhumane, and heartbreaking condition of emergency medicine after the pandemic.

While the emergency department functions 24/7/365, much of the rest of the hospital maintains banker’s hours. Converting semiprivate to private rooms, which may improve patient satisfaction, limit hospital capacity. Shortages of nursing and other ancillary services have reduced the ability to operate at full capacity. Overcrowded hospitals, one symptom of which is emergency department boarding, results in lower quality of care for patients, staff burnout, and increased mortality.1 The appropriate solutions are not casting blame on low acuity patients, most of whom we can see and discharge easily. Instead, administrators, regulators, and lawmakers need to focus on blockages elsewhere—the distribution of elective surgeries, early discharge of patients before noon, discharge on the weekend, and providing surge capacity for hospitals. If not, the stories you will read on page 12 will continue to accrue. And while we struggle to deliver the best care possible to our patients, we will not hesitate to speak out.

Dr. Cedric Dark

Dr. Dark (@RealCedricDark) is associate professor of emergency medicine at Baylor College of Medicine and the medical editor in chief of ACEP Now.

  1. McKenna P, Heslin SM, Viccellio P, et al. Emergency department and hospital crowding: causes, consequences, and cures. Clin Exp Emerg Med. 2019;6(3):189-195.