As frontline providers in Emergency Medicine, we are tasked with navigating every curveball that is thrown our way. From staffing shortages to bed availability, this episode sheds light on the root causes of boarding and innovative strategies that incoming Emergency Medicine providers can use to address it. In this episode, hosts Shannon and Molly are joined by guests Christopher Colbert, DO, and Mary McLean, MD to discuss the intricacies of ED boarding.
What is ED Boarding?
For those unfamiliar with the term, “boarding” is a common occurrence where patients are admitted but must wait for transfer to another hospital or a different floor within the same facility. This practice can last anywhere from a few hours to well over a day. Boarding is mainly driven by factors such as staffing shortages, lack of available beds, and spatial constraints. While unorthodox, boarding serves as an alternative that allows hospitals to accommodate patients when space and resources are scarce. Nonetheless, it remains a point of frustration for many ED providers, as it poses constraints on patient care and workflow. Additionally, concerns for patient safety and confidentiality remain an issue when hallway beds are utilized. With the volume of patient admissions being consistently high, it is important for incoming ED providers to understand the multifaceted nature of boarding and how they can navigate its challenges effectively.
Innovative Thinking
Even though patients are admitted, they’re still physically closest to us while in the ED, which means we are the ones responsible for thinking outside the box in terms of delivering patient-centered care. Dealing with ED boarding calls for us to be flexible and inventive in how we deliver this care. It’s not always easy, but we’ve got to focus on what we can do to keep our patients safe. This means getting creative with solutions, whether it be through creating privacy screens to give patients some dignity in hallway beds or creating an environment for patients to talk freely and feel heard by stepping into a safe space to talk. While it may not be the ideal scenario, it’s important to communicate openly with patients and cater to their individual needs, recognizing that some may require more urgent attention than others. As ED providers, it is important to focus on what is within your control and find ways to address these challenges, seizing every opportunity to learn and make a positive impact on our patients’ experiences.
What Can Students Do?
For medical students, the issue of ED boarding presents both learning opportunities and ethical considerations. While education remains a top priority, students are encouraged to actively seek ways to assist in patient care, performing thorough assessments and advocating for appropriate accommodations. This means ensuring no shortcuts are taken in examinations and finding creative ways to provide thorough care, even in the midst of limited resources.
Students can also play a crucial role in improving patient outcomes by engaging in unofficial ED rounding and addressing patients’ comfort needs, such as providing warm blankets or simply checking in on how they are feeling. These seemingly small gestures can significantly contribute to a positive patient experience while also enhancing the students’ own education. By collaborating with the entire ED staff and being willing to tackle challenges as they arise, students can navigate the complexities of emergency medicine while prioritizing patient safety and well-being. Additionally, their efforts can be particularly helpful for residents and attendings who may have limited availability to check on boarded patients, ensuring that all patients receive the attention and care they deserve.
Take-Home Points:
- While it may be inconvenient at times, use this as an opportunity to be flexible in your practice.
- Don’t miss out on patient histories or exams due to limited resources– find creative ways to get full assessments!
- Be a team player; see what you can do to help while still bolstering your education.
About Our Guests:
Associate Professor of Clinical Emergency Medicine, Associate Program Director, and Director of Medical Student Education, UIC BrownCoat EM Residency Program
Mary McLean, MD
Associate Program Director, AdventHealth East Orlando EM Residency Program
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