USA: My emergency patients wait hours — or days — for a hospital bed


It has been well-documented that Covid-19 took a devastating toll on emergency departments nationwide, revealing and exploiting the fragility of our acute-care system. Less has been written, however, about the side effects of hospitals’ attempts to recover from that era — one of the most serious of which is the proliferation of boarding.

As hospitals scramble to regain their footing (and their profit margins), the financial incentive structure that undergirds US medicine has gone into overdrive. Inpatient beds that might previously have been reserved for patients who require essential care but generate very little money for the hospital, are increasingly allocated for patients undergoing more lucrative procedures.

The consequences of this systemic failure cannot be overstated. Four hours is supposed to be the maximum time spent boarding in an emergency department, but recent data shows that hospitals in the US are failing to meet that goal when occupancy is high (which it routinely is).

"On any given shift, hallways in the emergency department are lined with patients on stretchers. Boarding leads to a cascade of harms — including ambulances diverted to hospitals far from patients’ homes, patients charged for beds they haven’t yet occupied and overwhelmed emergency medicine personnel leaving the field because of burnout," says Hashem Zikry, an emergency medicine physician and a scholar in the National Clinician Scholars Program at UCLA.

Many narratives around boarding focus on the patients themselves, shaming some for inappropriately using the emergency department. Proposed solutions include pushing patients to urgent-care centers or modifying “patient flow.” But the issues with boarding cannot be addressed with such minor tweaks.

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Source: The Washington Post, 28 February 2024