Lawmakers take aim at boarding in hospital emergency rooms | Bills & Laws

The skinny

Lawmakers in the House and Senate have sponsored legislation that is aimed at addressing the high volume of patients in hospital emergency departments.

Summary

The legislation, dubbed the Addressing Boarding and Crowding in the Emergency Department Act, would authorize the collection of data on patient volumes in hospital emergency rooms. Lawmakers say the measure would also direct studies to improve emergency care and help support new approaches to tackle the problem of boarding in the emergency department.

Sponsors

Republicans and Democrats are backing bills in both chambers of Congress.

U.S. Reps. John Joyce, a Pennsylvania Republican and a physician, and Debbie Dingell, a Michigan Democrat, are co-sponsors of the House bill (H.R. 2936). U.S. Sens. Chris Coons, a Democrat from Delaware, and David McCormick, a freshman Republican from Pennsylvania, are sponsoring the bill in the Senate (S. 1974).

Other lawmakers in both parties have signed on as co-sponsors.

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Analysis

Hospitals have wrestled with patients staying in emergency departments for extended periods. Hospitals have said patients routinely have waited in the emergency department for hours for beds, but some delays have stretched into days. Health systems say they’re essentially boarding patients in the emergency department.

Hospital executives and clinicians say the problem is driven by multiple reasons. Hospitals have had trouble finding beds for patients in emergency departments due to delays in discharging patients to nursing homes or rehabilitation facilities.

Hospitals have seen more patients with mental health emergencies, and those coming to the emergency department because they lack insurance and can’t get primary care.

The Emergency Nurses Association has backed the legislation.

Ryan Oglesby, president of the Emergency Nurses Association, told Chief Healthcare Executive in a recent interview that boarding is bad for patients and for staff.

“The patients are there longer,” he said. “They are there 12 and 24 hours, sometimes days.”

For nurses, patients who stay in the emergency department for longer periods pose problems in providing appropriate care.

“We certainly want to promote taking care of higher acuity patients better,” Oglesby said. “The downside of that, however, is that it's the community that then suffers. So the more and more boarding that happens in the emergency department, the less and less space there is to treat the community and to be available for the community as you are.”

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What they’re saying

Joyce, a dermatologist, said the problem is getting worse for hospitals and their communities due to long waits in emergency departments.

““Throughout the country, American patients cannot receive the care they need due to the lack of open hospital beds and long wait times, which have only increased due to the physician shortage,” Joyce said in a statement.. “By allowing the use of public health data modernization grants to create systems that track hospital capacity, this data will allow us to identify and implement solutions that will lower wait times for American patients.”

Coons said he’s heard from plenty of Delaware residents about the problem.

“If you’ve ever had to go to an emergency room in Delaware, you know that wait times are just too long,” Coons said in a statement. “Too many patients end up having to wait hours, or even days, for a bed to open up in the hospital, no matter the emergency.”

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