Emergency department boarding: a healthcare crisis

Emergency department crowding has been declared a public health crisis in the United States with millions seeking healthcare predominately though this department nationwide. Crowding worsens when the department is used to provide care to admitted patients. Seventeen percent of care hours are spent on boarded patients. The increase in population, life expectancy, and chronic illness increases the number of patients admitted to hospital inpatient units, which results in boarding in the Emergency Department due to lack of beds. Non-emergent visits also impact boarding. The literature most commonly defines this hold period as the time from admission bed request to the time of physical departure from the emergency department. Patient boarding causes delays in care, ambulance diversion, revenue loss for the hospital and providers, and increased medical negligence claims. Research reports that increased length of stay in the emergency department post admission to the hospital, leads to disruption of department flow, delays in care, and increased mortality. Existing literature on the issue of boarding will be reviewed to document that it is a problem affecting not only patients and emergency nurses, but all professionals and specialties across the acute care setting. Causes, consequences, and implications for nursing practice are discussed. Recommended interventions will include education programs that target emergency department boarding and throughput for acute care nurses. Specially trained mental health nurses and social workers are needed to address emergency department disparities and unsafe environments caused by boarding. Partnerships between the emergency department and inpatient units are necessary to get patients to the appropriate floor in a timely manner in order to increase patient safety and satisfaction.