Boarding in the ER

Excerpted from an article in the Washington Post, "Holdover in the ER"

The boarder phenomenon arises because there are not enough hospital beds and nursing staff to accommodate all the patients who need to be admitted on an emergency basis. Financial incentives reward hospitals for keeping their beds full, which favors patients scheduled for elective procedures. As a result, few empty beds are available for ER patients. Besides, Medicare pays hospitals more for taking care of a patient who has elective surgery than a patient like Rowe, who has a medical emergency. So there is built-in financial resistance to admitting many patients from the ER.

Yet, boarding is hazardous to health and it increases costs. Last week at the annual meeting of the Society for Academic Emergency Medicine in New York, researchers presented a study of 50,322 patients from 120 hospitals who were admitted to the ICU from the ER over a three-year period. Boarding in the ER for more than six hours led to increased mortality in the ICU and on the medical floor, longer hospital stays and higher than expected costs.