Caring for patients in the emergency department when there are not enough inpatient beds — ED boarding — is a long-standing practice in hospitals that are over capacity. Not only does it risk patient safety, but clinicians say it's burning them out, too.
In a questionnaire, published in the Dec. 2023 issue of The Joint Commission Journal on Quality and Patient Safety, 94 attending physicians, resident physicians, advanced practice providers and nurses in the ED reported that in addition to contributing to burnout, the practice of ED boarding also puts clinicians at risk for increased verbal and physical abuse from patients receiving the care nontraditionally while waiting for a bed to open.
Following the questionnaire, a focus group of 39 clinicians discussed the issue of ED boarding and collectively echoed that they feel patients on the receiving end of boarding end up with much lower quality of care and that communication breakdowns related to their care can happen more often. They also expressed feeling that as clinicians, "they lacked knowledge, resources and training to care for boarding patients," according to a Nov. 28 news release.
"While the importance of clinician burnout cannot be dismissed, the most important impact of boarding is on the patients and families who rely on the emergency department," Richelle Cooper, MD, and David Schriger, MD, emergency medicine physicians with UCLA Health, wrote in an accompanying narrative to the published results. "Boarding results in poor quality care and patient harm, not just for the admitted patients waiting for an inpatient bed but for all patients seeking care in the ED."
As possible solutions, clinicians in the focus group cited proactive planning of beds and resources, as well as a culture change to overhaul the practice that has sometimes become a norm for hospitals.