Hospitals Killing ER Patients?

Slate had an article by two Emergency Room Physicians about how the Emergency Rooms across the country are having a problem with large waiting time for patients to be seen by the physicians and boarding of patients (patients wait in the ER's for an Inpatient bed due to the Inpatient beds been full) in the ER's. According to the authors, hospitals have a huge financial incentive to keep the patients boarded in the ER.

Having worked in a local ER in Columbus, OH for the last three years, trying to tackle this same issue, I had to chime in with my two cents on this topic. Below is my response to the article which is also posted on Slate.

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Though I agree that boarding of patients in the ER is a huge problem in all of the ER's across the country, I disagree with the authors point of view that patients are boarded in the ER because there is a financial incentive to do so.

Assuming the authors point that boarded patients are mostly uninsured or underinsured, which can be disputed as well, aren't the boarded patients occupying ER resources in terms of nursing and physician time for which the hospital is responsible for if the patient cannot pay for the same. Also they are occupying a valuable ER bed which can be used for treating the next patient coming in.

Ultimately 99% of these boarded patients will be transferred to the Inpatient floors where they will consume the same amount of resources, as they would have before, if they were not boarded. So I do not see the financial incentive of keeping these patients boarded in the ED. Infact I see the opposite or more of an incentive to get the patients out because they will be consuming more resources then is necessary.

Patients are boarded in the ER not because a hospital has a financial incentive to do so, but because there are so many inefficient and redundant processes both in the ER and on the inpatient floors. There are a lot of factors that contribute to these inefficiencies including when physicians round on the floor, mismatch between the peak discharge time and peak admission time, poor communication between the various individuals involved in moving the patients through the system including ER and Inpatient nursing, bed cleaning, transportation etc.

Attributing boarding to a financial incentive would be a wrong way to approach this problem. Infact the focus should be on ironing out the inefficiencies and improving the processes in the ER and Inpatient floors.
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