ACEP Urges Biden Admin to Address Emergency Department Boarding

The American College of Emergency Physicians (ACEP) and over 30 medical associations have urged the Biden Administration to assemble a summit of healthcare stakeholders to address immediate and long-term solutions to excessive emergency department (ED) boarding.

Boarding occurs when admitted patients are held in the ED because no inpatient beds are available. This can severely impact patients waiting to receive care elsewhere and patients waiting to receive care in the ED.

Boarding has always been a problem in EDs, but the recent staffing shortages and increased physician burnout caused by the COVID-19 pandemic have exacerbated the issue.

In a letter to President Biden, ACEP detailed the challenges boarding creates for its members and stressed the importance of identifying timely solutions.

Other signatories included the American Medical Association, the American College of Radiology, and the National Alliance on Mental Illness.

The majority of ACEP members who shared stories said that patients experienced boarding times of more than 24 hours. Waiting that long to receive care can be fatal for many.

When neither ED nor inpatient hospital beds are available, patients are frequently redirected to the waiting room, leading to overcrowding. In addition to walk-ins, EDs see patients brought in by emergency medical services (EMS) via ambulance. EMS staff must remain with patients until they are seen by a doctor, meaning ambulances may be stuck at hospitals for long periods of time.

ED boarding has impacted pediatric care as well. Cold and flu seasons had led to children’s hospitals operating at over capacity, increasing the chances of ED boarding.

ED visits among children have increased during the pandemic, particularly the amount of mental health-related visits. Past studies have shown that pediatric patients with mental health conditions who are boarded are more likely to leave without being treated and less likely to receive counseling or psychiatric medications, the letter noted.

Adults with behavioral health needs are also facing the repercussions of ED boarding. Americans have limited access to outpatient mental healthcare. This can cause an influx of patients to the ED and prevent patients from being discharged from inpatient psychiatric care and freeing up a bed for those waiting in the ED.

ED boarding has exacerbated healthcare worker burnout.

“Overcrowding and boarding in the emergency department is a significant and ever-growing contributor to physician and nurse burnout, as they must watch patients unnecessarily decompensate or die despite their best efforts to keep up with the growing flood of sicker and sicker patients coming in,” ACEP wrote.

Burnout increases the likelihood of healthcare workers retiring early or leaving the profession altogether. Staffing shortages have persisted throughout the pandemic, with burnout being one of the main reasons practices and hospitals are losing workers.

Due to these shortages, EDs are often the only place to keep patients as they are not subject to the same staffing ratio requirements as other parts of the hospital, the letter noted.

According to ACEP, misaligned incentives in how healthcare is financed have allowed patient boarding to continue. Giving beds to elective admissions and boarding non-elective patients in the ED has financial benefits that exceed the cost for hospitals. However, emergency care staff and patients are the ones suffering, ACEP said.

“We greatly appreciate the commitment and attention your Administration has given to the health and safety of those in our nation over the last two years, and we implore you to now make the growing crisis of boarding a major priority,” the letter concluded.