Inpatient Boarders?

Specialties Emergency

Published

  1. Does your ED have boarders/mostly boarders?

    • 3
      Yes, we have around 50% (or more) boarders at any given time!
    • 9
      We have boarders, but not taking up 50% of our beds.
    • 6
      We might have a few each day.
    • 3
      Rarely do we have IP boarders.
    • 7
      No, this is not a problem.

28 members have participated

I work in the ED in a mid-size city in New York. It seems that the hospital floors are always full, and most of the time we have over 30-40 inpatient boarders, sometimes up to 55. We have 60 beds in our acute area, and this leaves almost no normal patient care areas in which to treat ED patients (and so we have 50+ in the waiting room every day). We end up treating patients in stretchers and chairs in the hallways, and most of the time, my colleagues and I are acting as med/surg nurses because someone has to take care of the boarders. The ED looks like a war zone with people stacked up in the hallways.

When bringing this up to any of our nurse leaders, we're told hospitals are like this everywhere and we shouldn't complain (or go anywhere else) because everywhere else has it this bad.

I guess this is all a roundabout way of asking: Do other hospitals actually have these problems/is it that bad everywhere? I hear back from people who have left to travel and it seems like they don't have these problems.

Sidenote: Then again, we're also told to shut up about our 6:1 staffing because back in their day it was 8:1 and we should just be thankful to be 6:1 with no PCTs, even if you have ICU players. So maybe I'm just salty in general.

Billing inpatient (and in many cases not only inpatient but ICU inpatient) status while the patient is being intermittently watched in a department whose mandates are to provide rapid screenings of large numbers of other people and institute care for emergencies? And whose nurses have assignments that preclude providing inpatient/ICU level care?

An appropriately-staffed ED-observation unit is one thing. Boarding inpatients who are being billed for inpatient-level care in a unit where they are not receiving it is an entirely different ball of wax.

And all of that without addressing how this affects the care of those who present for MSE/evaluation for possible emergency/urgency and have not yet been fully evaluated.

Billing inpatient (and in many cases not only inpatient but ICU inpatient) status while the patient is being intermittently watched in a department whose mandates are to provide rapid screenings of large numbers of other people and institute care for emergencies? And whose nurses have assignments that preclude providing inpatient/ICU level care?

An appropriately-staffed ED-observation unit is one thing. Boarding inpatients who are being billed for inpatient-level care in a unit where they are not receiving it is an entirely different ball of wax.

And all of that without addressing how this affects the care of those who present for MSE/evaluation for possible emergency/urgency and have not yet been fully evaluated.

I doubt the OP's hospital cares about their fraudulent practices nor will they stop until busted by the state or feds for billing practices or unsafe operating conditions.

The whole reason they are operating the way they are in the first place is to keep as many patients as possible, in order to maximize profits. They are putting their profit potential ahead of patient safety and until someone dies or the state's oversight agency smacks them on the hand for it, they will continue doing it.

The whole reason they are operating the way they are in the first place is to keep as many patients as possible, in order to maximize profits. They are putting their profit potential ahead of patient safety and until someone dies or the state's oversight agency smacks them on the hand for it, they will continue doing it.

This happens way more than it should and I've seen it happen so many times. You're right.

Specializes in ED, Cardiac-step down, tele, med surg.

I have never worked in a hospital with that problem. Even my first ER job, which was a very busy high acuity facility never boarded that many patients at one time. Maybe we would have a few that would stay sometimes up to 3 days but never 50 patients. That's crazy, I can't even imagine that. I would start looking for another job if I had to work like that all the time. I had a coworker from NY and she told me about how crazy her ER was with the "Hallway ICU patients". I worked with a traveler who was from NY, he had some crazy stories too. I'd never want to work that way.

My facility is really bad for this. It's not uncommon to have literally every single room filled with inpatient boarding, and be intubating people in the hallway, moving inpatients into the hallway for traumas, etc. It's unsafe, and is resulting in extremely high turnover (I'm leaving soon too). Our clinical coordinator told me that our annual turnover is >80%. What's particularly frustrating is that we will be working under conditions as I mentioned, and then the facility will accept transfers from other facilities who...turn into inpatients and get held in the ER. It's truly terrible.

My facility is really bad for this. It's not uncommon to have literally every single room filled with inpatient boarding, and be intubating people in the hallway, moving inpatients into the hallway for traumas, etc. It's unsafe, and is resulting in extremely high turnover (I'm leaving soon too). Our clinical coordinator told me that our annual turnover is >80%. What's particularly frustrating is that we will be working under conditions as I mentioned, and then the facility will accept transfers from other facilities who...turn into inpatients and get held in the ER. It's truly terrible.

Wow.

I don't think I even want to hear it...but have they ever mentioned a rationale for accepting transfers for which they don't have the capacity to care? They have to have the capacity or there is no EMTALA obligation to accept the transfer...

My facility is really bad for this. It's not uncommon to have literally every single room filled with inpatient boarding, and be intubating people in the hallway, moving inpatients into the hallway for traumas, etc. It's unsafe, and is resulting in extremely high turnover (I'm leaving soon too). Our clinical coordinator told me that our annual turnover is >80%. What's particularly frustrating is that we will be working under conditions as I mentioned, and then the facility will accept transfers from other facilities who...turn into inpatients and get held in the ER. It's truly terrible.

Boarding is categorically called out by the Joint Commission as a safety hazard. If your facility is repeatedly ignoring or purposefully creating the situation, then I'd suggest dropping a professionally worded but anonymous complaint to the Joint Commission alerting them that they need to do an inspection of your hospital.

Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.
I'm not an ED nurse, so forgive my ignorance; are ED holding units uncommon? Not necessarily on a different unit/floor, but I've worked a few places as a traveler where we designate a block of ED rooms for boarders and us floor nurses will take them until they get a bed. Doesn't solve the space problem but a few float nurses to manage them would let you focus on your ED patients. But like you said, it sounds like your hospital is satisfied with the way things are, so I doubt suggesting that would get you anywhere.

My department may create these ad hoc when we have 3-4 boarders, but that's rare and usually a result of flu season. If a unit is doing this on a regular basis, that's evidence of a structural throughput problem on the inpatient side. Holding people in the ED should be the exception, not the rule, as many people here have already pointed out - it stresses the department and patients receive sub-standard care.

When I was initially hired, we never had boarders or went on bypass, but then our corporate overlords were a bit overly-enthusiastic during a round of belt-tightening one Fall and closed down an entire med-surg unit and cut the number of ICU beds in half, then wondered why we suddenly went on Bypass on a weekly basis that Winter. There was a smaller med-surg floor that was opened up later, and that was slowly staffed up, but the damage was done.

Since then, we've had issues with holding patients in the ED most winters, but it's usually no more than 1-3 at a time. I have to agree with other posters - if a given department is regularly holding inpatients to the point they have to put pts in the hallways as a matter of course, anonymous tip-offs to both the Joint Commission (or HFAP) and your state's relevant regulatory bodies are definitely in order.

And no, hospitals everywhere aren't as bad as OP's. If my time reading this board has taught me anything, New York is a messed-up place, and NYC is doubly so.

Specializes in ER, ICU.

Yikes, that seems a lot. Hospitals are not like this everywhere. Saying you have it good because your ratios are less bad than before equals- you are lucky to be beaten once a day when we were beaten 5x per day. If I was a sex trafficker this would be called normalization. The fact is, you are not trained to provide the same standard of care of the ICU or tele, and patients will not effectively receive the same level of care. For leadership to expect that is unrealistic and unfair. This sounds like systemic failure and should be treated as such. Leadership should have the integrity to tell you this sucks, and we're sorry, but here's our plan to change it, not- suck it up because it used to be worse. If there is no sign of the situation getting better, I would move on. Good luck.

1 Votes

I work in a busy ER in Southwest Florida. We have 32 rooms but use hallway beds and chairs. We also have a fast track area and a rapid treatment area that is in the waiting area for patients who are not going to be admitted. We see around 240 and up patients a day and we are just now coming into season so those numbers will go up. There are times when we don't have any holds but during the high season months we will hold 30-40 patients. We mainly have them in the hallways unless they are in isolation and then they are in a room. We also use hold nurses which come from the floors or resources pool but sometimes as the ER nurse we do take care of the hold patient.

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