Emergency physicians are awaiting Congressional action on legislation aimed at addressing one of the most serious aspects of emergency department (ED) overcrowding – inpatient boarding, this despite the hospital industry’s claims that the effort falls short of zeroing in on the real problem faced by hospitals.
Two companion bills were introduced in Congress early last year, HR 882 and S 1003, that attempt to address the boarding issue. If enacted into law, they would require that hospitals report delays in moving already admitted patients from the ED to an inpatient bed.
The U.S. Department of Health and Human Services would collect the data to study the problem and find ways of eliminating or at significantly reducing the amount of boarding in EDs. Hospitals that fail to report the numbers would risk losing their Medicare certification.
The legislation has met with growing support in Congress and the American College of Emergency Physicians, which helped sponsor the bills.
“This legislation will increase access and efficiency, which in turn will lower costs and improve patient satisfaction and safety,” said Nick Jouriles, MD, an Ohio-based EP and ACEP vice president.
The measures require that a bipartisan commission be set up to study the causes of overcrowding and the related problem of obtaining available on-call specialists as well as the economic impact of boarding and the medical liabilities associated with it. The bills also authorize extra Medicare payments to physicians who provide EMTALA-related care.
But the hospital industry has countered that the measures, though well-intentioned, don’t go far enough. “They ignore the problem of why,” said Roslyn Schulman, a senior associate director for policy development at the American Hospital Association in Chicago.
The legislation, Schulman said, doesn’t address the reasons for the back-ups in the first place, including a severe and growing nursing shortage, a persistent on-call specialist problem, and the economic forces that push hospitals to close whole inpatient departments including needed beds.
“It’s a very complex issue. Simply requiring public reporting isn’t going far enough,” Schulman stated.
Sandra Schneider, MD, disagrees. The bills establish for the first time that boarding exists, that it is more expensive, it increases hospital lengths of stay, and jeopardizes patient safety, said Schneider, an ACEP director and an EP at the University of Rochester Medical Center in New York.
“In terms of the legislation not going far enough, it is an important first step,” Schneider stated. As a solution, she recommended altering inpatient discharge schedules to free up more beds and moving patients up to other wards.
It would, Schneider said, free up ED space and provide patients with better care in settings where nurse-to-patient ratios are better and where care in many cases is more specialized.
The recommendations were contained in a report submitted recently to the ACEP executive committee by a special ACEP task force on overcrowding and boarding. The AHA has reportedly opposed such moves but has not yet specified a reason.