Hospitals taking steps to limit ED patient 'boarding'

The Wall Street Journal on Wednesday examined how a "growing number of hospitals are taking steps" to limit the practice of "boarding," in which hospitals admit emergency department patients when no rooms are available and leave them in hallways for extended periods of time.

According to the American College of Emergency Physicians, half of medical directors surveyed this year reported boarding one to five patients for four or more hours daily, and the practice is the main cause of overcrowded EDs, long waits for treatment and ambulance diversions.

Boarding also can increase liability risk for hospitals because the conditions of boarded patients, who often are critically ill and "less likely to be carefully monitored" by hospital staff, "can deteriorate quickly," the Journal reports.

In response, physicians this week at the annual ACEP meeting in New Orleans discussed a number of strategies to limit boarding at hospitals.

For example, hospitals could: use industrial production models to move patients through the ED more efficiently; eliminate delays in registration and laboratory tests for ED patients; require other hospital departments to care for additional ED patients through "Adopt-A-Boarder" programs; ask nurses from intensive care and other units to accept more ED patients; and open special observation units or provide home health aids to avoid admission of ED patients.

Meanwhile, legislation under consideration in Congress would offer financial incentives to hospitals that eliminate or limit boarding (Landro, Wall Street Journal, 10/18).