May 2024 President’s Message
Hospital boarding problem is anything but boring
by Howard Chang, MD —
As many of you are already aware, hospital boarding has reached an all-time high. In this month’s column, I aim to provide a succinct overview of hospital boarding, its underlying causes and the far-reaching implications it entails.
Defining hospital boarding
So, what exactly is hospital boarding? Put simply, it refers to the practice of retaining patients in the Emergency Department after the admission order has been initiated. This metric is typically measured from the time the admission order is placed to when the patient eventually departs the ED. While we often like to consider ourselves unique, the reality is that hospital boarding has become an escalating issue nationwide.
Who is affected?
Who bears the brunt of boarding’s impact? The ramifications extend throughout the entire healthcare system, both locally and beyond. For Emergency Medicine physicians like me, it’s like trying to manage a bustling restaurant where every table is occupied, no one is leaving, and a queue stretches out the door. Oh, and every so often a customer will just start choking or spill hot soup on himself.
For surgeons, the backlog in the ED may hinder patients from promptly receiving elective surgeries or even urgent surgeries. Family physicians may face challenges in securing direct admissions. There aren’t any available beds to directly admit to when you have tens of admitted patients already waiting in the ED.
In rural areas, the situation is compounded. Accessing specialized care at tertiary facilities becomes arduous when neighboring hospitals are overwhelmed and refuse out-of-county transfers. This often necessitates transporting critically ill patients to distant medical centers, sometimes crossing state lines.
The adverse effects of hospital boarding have inundated our nation, state and city, fostering physician burnout, creating moral injury and compromising healthcare delivery.
Why does it happen?
The big question here is: Why is this happening? Boarding has become the new pandemic, debilitating our healthcare infrastructure. Its causative factors are manifold.
The nursing shortage is a primary concern. COVID-19 continues to haunt us today. Since the pandemic, fewer nurses are working within hospital systems. Retirement, lucrative travel nursing opportunities, and disillusionment with the demanding and under-resourced acute-care environment have driven many nurses away. Moreover, the allure of nursing as a career has dwindled among younger generations. Those who remain often grapple with horrible burnout. We’ve all felt it: The practice of medicine is starkly different post-pandemic than pre-pandemic.
One might wonder: Why don’t hospitals simply offer higher salaries to attract more nurses? These days, a hospital system can consider itself lucky if it just breaks even. Last year, the Center for Healthcare Quality and Payment Reform said that 84 of 102 rural hospitals in Kansas reported financial losses on patient services. The closure of 10 rural Kansas hospitals since 2005 underscores the severity of the situation. The most recent hospital in Kansas to close was in Herington, just 1.5 hours north of Sedgwick County. It shuttered its doors in October 2023 after 104 years.
Another reason why we are boarding patients is due to challenges in care coordination. Inability to secure timely and safe placement for admitted patients has plagued hospital systems for decades. Sometimes social and behavioral health factors – such as a housing shortage, substance use disorder or psychiatric conditions – require additional resources that a community lacks, making a safe disposition very tough.
No easy solutions
Addressing hospital boarding necessitates a multifaceted approach encompassing management, bolstering community resources, refining care coordination and communication, and fostering interest among young individuals to pursue careers in healthcare. The road ahead is fraught with challenges.
There are no easy solutions here. How do we get skilled nursing facilities to accept patients faster? How do we hire more nurses when there aren’t any? How do we hire more PT/OT? Or radiology technicians? How do we get floor nurses to actually accept phone calls from the ED (just kidding, sort of)? This is an extremely complicated dilemma we’re facing.
First, recognizing that hospital boarding transcends the individual hospitals is paramount. This is not simply an Ascension Via Christi or Wesley problem. We need a concerted, communitywide effort with innovative solutions to combat this burgeoning crisis.
Moreover, a focus on growing the next generation of healthcare professionals is imperative. The MSSC recently partnered with the Family Medicine Interest Group at KUSM-W to hold “Doc for a Day.” Our members discussed the medical field and different careers with about 60 middle and high school students.
This initiative was so fantastic and so necessary that we probably ought to expand on this and kick off “Nurse for a Night”! It’s vital that we do everything possible to inspire and cultivate future healthcare heroes.
As you all know and feel, patient care is more challenging today than ever before. You are all amazing physicians, and I hope my brief overview of hospital boarding has helped you understand the predicament we are all in.
Thank you for all you do to keep Sedgwick County healthy.