Emergency-sign

According to this story in the New York Times, “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.” Boarding is the practice of treating patients in hallways of busy Emergency Departments, frequently while waiting for an in-patient bed to become available.

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.

The group sent a 10-question survey about boarding to its
2,821 members in New York State, New Jersey and Connecticut. In New
York, 28.2 percent of those responding said they “personally had
experience of a patient dying as a result of boarding.”

In
Connecticut, 16.2 percent of the doctors responding said they had had a
patient die as a result of boarding, and in New Jersey 11.9 percent of
the doctors said they had.

The doctors requested anonymity and
were reluctant to provide details about cases because of possible
lawsuits and other repercussions.

You can chalk up this survey as another example of the increase in reporting of patient safety and outcomes:

Ms. [Julie] Lloyd [a spokeswoman for the American College of Emergency Physicians] said the survey was the first by her group, or any other she
knew of, to try to assess the number of deaths resulting from boarding.
She said in an e-mail message that a key point in legislation before
Congress “is to collect boarding statistics, which heretofore have
remained the province of the hospitals.”

Public reporting of boarding seems to be in our future, nation wide.

A spokeswoman for the New Jersey Hospital Association, Kerry McKean
Kelly, said she had “not heard of any deaths” resulting from boarding
in New Jersey, but “we don’t think there’s any disagreement” that
boarding and overcrowding are serious problems, and “everyone shares
responsibility on this issue.”

Don't kid yourself, boarded patients have died, in New Jersey and beyond. There are no statistics on this because hospitals don't code the cause of death to reflect the preventable adverse event that killed them like, “death from inattention due to boarding.” Harsh? Perhaps, but this is a long standing problem in which most hospitals still wring their hands and ask, “what can we do?” Here's what they did at Stony Brook hospital:

Dr. [Peter] Viccellio [vice chairman of emergency medicine] said 3,000 boarders had gone through the Stony Brook
hospital under his revised system and estimated that hundreds of
hospitals nationwide had begun using it.

The premise of his
regulations: When an emergency department is seriously overcrowded and
patients are boarded in the hallways, their care and that of any new
patient can be jeopardized. So emergency department boarders are moved
to the hallways of inpatient units — 10 at Stony Brook — where they can
be treated in a unit designed for their condition until a room becomes
available. Those units are also less crowded.

Dr. Viccellio
described his plan as a “decompression valve” that relieves the
pressure on emergency departments and results in “better care for all
patients, more timely treatment and fewer errors.”

He created
the system after years of frustration with boarding problems at Stony
Brook — a frustration felt throughout the country, said other doctors
who were interviewed.

Dr. Viccellio’s department often boarded up
to 15 to 20 patients before his protocol. Now, he said, when boarding
occurs it usually involves seven or eight patients. The most common
complaint for boarded patients is chest pains, he said.

Only two
patients can be assigned to another unit, he said, “so you might have a
situation where five nurses are treating 32 patients instead of 30” in
a given inpatient unit. That is far preferable, he said, to the
emergency department bearing the burden of overcrowding by itself.

Some
hospitals have expressed concern about the impact of Dr. Viccellio’s
system on nursing staffs, but spokeswomen for the New York State Nurses
Association and the Emergency Nurses Association, in Des Plaines, Ill.,
said that in general their groups support efforts to relieve boarding.

“I
think that studies have shown that whenever you put a patient on a
general floor, they get beds a lot quicker than when they’re out of
sight in an emergency department,” said Donna Mason, president of the
Emergency Nurses Association.

[Hat tip: FierceHealthcare]