According to a recent study, boarding ED patients can double the cost of care.
When there’s a bottleneck, it harms both patients in the waiting room and patients awaiting transfer for further care.
Over the years in the United States, emergency departments (EDs) have progressively evolved beyond their initial roles. EDs were conceived to treat acute injuries and illnesses, and to stabilize more serious cases before transferring them to appropriate levels of care. Now, they often serve as a very expensive source of primary care.
This evolution is partly due to the Emergency Medical Treatment and Active Labor Act (EMTALA), which since the 1980s has mandated medical examinations and stabilizing treatment regardless of insurance status. It is also a consequence of progressive failures in other areas of healthcare, such as mental health systems, particularly since the COVID-19 pandemic. As a result, EDs have increasingly struggled with the challenge of boarding, which is when patients requiring hospital admission or higher levels of care remain stuck in the ED, receiving treatment due to a lack of inpatient beds or specialized care, such as ICUs.
The effects of boarding are typically twofold: Patients who have been treated in the ED face delays in receiving inpatient care, while new patients in need of emergency treatment are unable to access it promptly. Beyond the immediate risks of ED boarding, additional downstream consequences — such as increased medical errors and higher rates of mortality and morbidity — are well-documented. A recent University of Massachusetts study by Dr. Maureen M. Canellas et al. highlights that ED boarding doubles the cost of inpatient care.
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The Hidden Risks of ED Boarding
The Joint Commission has established a four-hour wait time benchmark for emergency departments. However, studies have shown that most patients were not willing to wait longer than two hours, and that patients leaving EDs without being seen are at risk of almost 50% higher mortality.
EDs serve as sentinels for the overall health of any healthcare system. Owing to their fast-paced nature and the critical condition of many patients, issues such as staff burnout and patient dissatisfaction are significantly magnified within the ED context.
From the perspective of staff burnout, ED personnel — especially nurses — are at the highest risk, with more than 60% of ED nurses reporting burnout. And, ED physicians have exceptionally high suicide rates. It’s not a leap to see the stress of boarding as a contributing factor in job dissatisfaction amongst the ED personnel.
The Financial Impact of ED Boarding
Beyond the effects on patient outcomes and staff well-being, ED boarding also significantly impacts the bottom line. A recent study demonstrated specifically that boarding effectively doubles the daily cost of care for patients admitted through EDs when compared to those receiving inpatient care. For example, the cost of medical/surgery boarding for acute stroke patients was found to be $1,856 per day, compared to $993 for medical/surgery inpatient care. Similarly, ICU boarding costs were $2,267 daily, slightly higher than the $2,165 for ICU inpatient care.
The same study also demonstrated that these costs rose even further when taking into account confounding variables, such as the use of travel nurses. These economic burdens, combined with the associated risks to patient safety and staff burnout, highlight the urgent need for targeted interventions to address boarding and optimize resource utilization across healthcare systems.
Identifying Bottlenecks and Optimizing Resource Allocation
Although the causes of ED boarding are multipronged, research shows that ED boarding is an indicator of a less efficient patient flow. d2i’s Emergency Medicine Performance Analytics goes beyond basic metrics. Our analytics solution delves into every touchpoint of a patient’s ED journey, pinpointing bottlenecks and inefficiencies. Lags in diagnostics? Delayed admissions? Bed availability issues d2i exposes them all.
Imagine your ED staff, armed with actionable insights, dynamically reallocating resources, streamlining workflows, and fostering better department coordination. The result? Reduced boarding rates, smoother patient throughput, and most importantly, elevated quality of care.
d2i leverages historical data to predict surges in patient volume, seasonal trends, and potential crises. This foresight allows your ED to be nimble, adaptable, and better prepared.
Ready to see how d2i can transform your ED operations? Contact d2i today or book a meeting to learn how our Emergency Medicine Performance Analytics can help your facility stay resilient, responsive, and prepared for the challenges of modern healthcare.