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Hospital Boarding: A Dangerous Symptom of Overcrowding

It’s not unusual to experience an overcrowded emergency room.  Many patients have suffered as a result of understaffed or ill-prepared emergency departments: long waits; delays in receiving care; insufficient check-ins with nursing staff or doctors; being left in the dark altogether about what is going on with your treatment.

When a hospital’s emergency department is overwhelmed by a patient influx, patients in the department who need to be admitted to the hospital cannot be given beds in a timely fashion, which leads to the crowding of emergency departments and a longer wait to be admitted to the ER for patients who may need urgent care.  This can mean emergency department patients, already stuck in a hospital limbo, shuffled from one room to the next or, worse, out of rooms and into the hallways. This practice of moving emergency department patients from rooms to hallways is known as boarding.  It is a result of crowded emergency departments and an attempt to accommodate more patients.

An overstressed emergency department can deliver substandard care unintentionally.  Patients kept in beds in the hallways of emergency departments cannot receive necessary care, and their stay in the open areas of the department can make the patient prone to more external factors (such as traffic through the unit, possible hospital-borne illnesses).  This is not the exclusive fault of the emergency department, but instead points to flaws within the hospital admissions system and disparate factors affecting the efficacy of the treatment rendered to patients.

Serious problems that can occur if a patient is boarded in the hallways of an overcrowded emergency department include:

  • Delayed time-critical treatments and/or interventions
  • Increased or recurrent complications
  • Increased risk of medical error
  • Less frequent and/or adequate pain management
  • Prolonged hospital stay
  • Worsening condition
  • Increased cost for the patient (the consumer)
  • In some extreme cases, death (NY Times, “The Patients in the Hallways”)

These adverse effects of boarding and overcrowding cannot be ignored— it has been shown in various studies that overcrowding of emergency departments has a causal relationship with poorer patient care.

For more information on hospital boarding, see the American College of Emergency Physicians’ article on hospital boarding and possible interventions.

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