The Patients in the Hallways | NYT | 6.11.07
More than half the doctors from New York State, New Jersey and Connecticut who responded to a survey conducted in April by the American College of Emergency Physicians said that boarding had increased significantly in recent years.
Doctors attribute it to emergency department and hospital overcrowding. The Institute of Medicine, a nonprofit group that advises on medicine and health, said in a recent report that emergency department visits grew by 26 percent from 1993 to 2003 while the number of emergency departments and hospital beds was declining.
The consequences of overcrowding can be fatal, doctors said. A total of 150 emergency department doctors in New York, Connecticut and New Jersey said that patients in their hospitals had died as a result of boarding, according to the survey by the American College of Emergency Physicians, a 25,000-member group that is pushing legislation in Congress to fight hospital overcrowding. The survey specified no time frame.
Quite an irony, if we sat passengers in the aisle of an airplane for hours-to-days at a time that becomes a national scandal. Change industries, and it becomes common place management practice—a model of efficiency and cost control. Ah yes, when hospitals fly…
{ 2 comments… read them below or add one }
The Institute for Healthcare Improvement has done some good work around this. I discovered that most of the boarders have chronic diseases and fall in the medical service – lower reimbursement rates, while elective admissions skate right in around them. As soon as hospitals are forced to hold elective admissions until all ED boarders are placed in beds, ED boarding will stop as hospitals “magically” find beds and staff. One way to fight this is to count all admitted, but boarded patients on the inpatient census and attach them to the inpatient units they belong to. THe hospital can be held accountable by JCAHO in the Leadership Standard -for counting these inpatient boarders on the inpatient census and for providing safe nurse staffing to care for them..Personally, I believe that moving patients to inpatient hallways is a disaster – for fire safety, privacy and the potential to make mistakes in terms of patient ID, continuity of care and nurse workload.
Thanks for picking up on this. It's important, and the data supports clear discrimination in wait times based on medical diagnosis, assigned service and reimbursement rates.
The Institute for Healthcare Improvement has done some good work around this. I discovered that most of the boarders have chronic diseases and fall in the medical service – lower reimbursement rates, while elective admissions skate right in around them. As soon as hospitals are forced to hold elective admissions until all ED boarders are placed in beds, ED boarding will stop as hospitals “magically” find beds and staff. One way to fight this is to count all admitted, but boarded patients on the inpatient census and attach them to the inpatient units they belong to. THe hospital can be held accountable by JCAHO in the Leadership Standard -for counting these inpatient boarders on the inpatient census and for providing safe nurse staffing to care for them..Personally, I believe that moving patients to inpatient hallways is a disaster – for fire safety, privacy and the potential to make mistakes in terms of patient ID, continuity of care and nurse workload.
Thanks for picking up on this. It’s important, and the data supports clear discrimination in wait times based on medical diagnosis, assigned service and reimbursement rates.