Patient Boarding in the Emergency Department: Keeping Safety, Quality and Engagement at the Forefront
Patient boarding - holding admitted patients in the Emergency Department (ED) rather than transferring them to other inpatient units - is a tactic used by many EDs struggling to cope with high demand. A recent survey conducted by Studer Group reviewed the extent of patient boarding across the United States, and examined the impact of boarding on patient experience, quality of care, patient safety, and ED staff and physician engagement. This Insight introduces highlights from the survey, along with some of the most effective tactics for reducing patient boarding.
The annual number of ED visits in the United States has grown in recent decades by nearly 32 percent.[i] The American Hospital Association reports that 69 percent of urban hospital EDs and 33 percent of rural hospital EDs are operating at or over capacity.[ii]
Patient boarding has become a common practice, and overcrowding in EDs threatens public health by compromising patient safety and jeopardizing the reliability of the emergency care system.
Survey Results Highlight the Negative Impact of ED Patient Boarding
Studer Group surveyed more than 630 ED directors from 48 states, representing hospitals ranging in size from 6 to 1,887 beds. Respondents were asked about the extent of ED patient boarding and the impact on patient experience, quality of care, and employee and physician engagement. Overall, a clear majority of ED directors agree or strongly agree that:
Patient boarding negatively impacts patients' ED satisfaction ratings and overall hospital satisfaction ratings.
Patient boarding negatively affects quality of care and patient safety. It increases the risk of adverse events and poor clinical outcomes, and contributes to lower physician productivity
Patient boarding negatively affects the ED staff work environment. It increases job stress, reduces job satisfaction and morale for nursing staff, and increases nursing staff turnover
Solutions are Available to Reduce Patient Boarding and Overcrowding
Fortunately, there are steps ED leaders and frontline staff can take to mitigate the negative impact of patient boarding. These focus on ED process, patients and people - your ED employees and physicians:
Process: Start by aligning organizational goals across departments. Then begin working through the entire admit-to-discharge process to identify opportunities to decrease patient boarding. This can be led by a hospital throughput committee composed of cross-departmental stakeholders.
Bed huddles bring together inpatient unit leaders, hospitalists, case managers, and other staff to verify confirmed discharge and anticipated discharge patients. Leverage data to forecast anticipated volumes of admitted and discharged patients, so staff can be proactive and ready to receive patients rather than reactive to crisis situations.
Use ED occupancy surge plans to map out action plans and required responses for each department when the ED reaches a saturation point.
Patients: Effective and timely communication helps manage patient perceptions of care during times of patient boarding. AIDET® (Acknowledge, Introduce, Duration, Explanation, and Thank You) is a communication framework that reduces patient anxiety and builds trust in providers. Different components are emphasized at different times - regular updates on Duration are typically the most critical component for boarded patients.
Another key tactic is rounding on patients by inpatient nurse leaders. Rounding gives leaders the opportunity to express empathy, to thank patients for waiting for an inpatient bed, to reassure patients and families that the team is working to solve the problem, and to provide updates on bed availability.
People: A major source of dissatisfaction for employees is experiencing reoccurring problems with no solutions or plans for change offered by leaders. Leaders can learn about barriers by rounding on ED staff. It is imperative to follow up on commitments and work to remove barriers.
If requirements for additional equipment or staff are identified, consider using an area that is open at designated times for overflow patients. Bring in Med/Surg, Tele or ICU nurses to assist with managing admitted patients. Engagement will improve when ED employees have the right environment to do their best work.
For information about specialized Canadian ED coaching partnerships or ED assessments, contact Ashley.firstname.lastname@example.org. For additional tools, articles and whitepapers, go online to Studer Group Canada's complimentary healthcare resources page.
[i] Pitts SR, Niska RW, Xu J, Burt CW. "National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary," National Health Statistics Report; no. 7. Hyattsville, MD. National Center for Health Statistics. 2008. Available at: https://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf
[ii] "Taking the Pulse: The State of America's Hospitals," American Heart Association. Available at: http://www.aha.org/aha/content/2005/pdf/TakingthePulse.pdf.