ACEP to CMS: Require Hospital Plans to Address Boarding in Emergency Departments

WASHINGTON, DC-The American College of Emergency Physicians (ACEP) calls on the Centers for Medicare and Medicaid Services (CMS) to require hospitals to develop and implement response plans to better address boarding in the emergency department.

"Overloaded health systems are jamming emergency departments with admitted patients waiting for inpatient beds to become available-people's lives are at risk," said Aisha Terry, MD, MPH, FACEP, president of ACEP. "Boarding of these patients is a deadly combination of systemic delays and dysfunction that has become a public health crisis. Emergency care teams are doing all they can, but patients deserve better."

ACEP proposes that CMS update its emergency services Condition of Participation (CoP) with a requirement for hospitals to have a plan in place, and to act on it, when the number of patients boarding in the emergency department for hours, days, or longer until a staffed inpatient bed becomes available exceeds a particular threshold.

The letter said:

"ED boarding and crowding are not caused by ED operational issues or inefficiency; rather, they stem from broader health system dysfunction. This dysfunction also leads to negative patient outcomes, as a substantial body of evidence has shown that ED boarding and crowding lead to increased cases of mortality related to downstream delays of treatment for both high and low acuity patients.

Boarding can also lead to ambulance diversion, increased adverse events, preventable medical errors, lower patient satisfaction, violent episodes in the ED, emergency physician and staff burnout, and higher overall health care costs."

ACEP's proposal is designed to be flexible for facilities of all sizes and locations with protocols that can be customized based on specific staffing arrangements and other considerations.

This is the latest piece of ACEP's comprehensive campaign to address boarding in emergency departments that includes alerting the White House, gathering hundreds of troubling stories directly from the frontlines, convening the nation's first stakeholder summit on boarding, tying boarding-related attestations to hospital performance measures, and advocating for solutions at the state and national level.

"Challenges that arise from boarding are often seen in emergency departments, but that's not where they start," said Dr. Terry. "Emergency physicians cannot solve this crisis alone. Solutions require collaboration across the health care continuum. Together, we must address the root causes of boarding in the emergency department to provide better, faster care for our patients."