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Right Quality Measures to Fix Problem of Emergency Department Boarding

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An article in Health Affairs highlights the issue of Emergency departments (EDs) across the country being at their breaking points due to excessive boarding of patients waiting to be admitted to the hospital. But the true root of the lack of ED capacity is due to patients waiting in the ED until an inpatient bed becomes available. Boarding refers to this practice of holding admitted patients in the ED when there are no inpatient beds available. It occurs when patients present to the ED, either for an initial evaluation or after being transferred from another hospital, and then wait an extended period of time to move from the ED to a hospital ward.

Boarding is associated with several adverse outcomes including increased medical errors and death, likely because the ED is ill-equipped to provide longitudinal and focused inpatient care and attention is frequently diverted to new patients who present with undifferentiated conditions. Despite these trends, the fact that boarding occurs is not surprising. Rather, it has become an expected outcome of our customarily misaligned incentives in health care financing.

The authors call on agencies such as CMS and accreditors such as the Joint Commission (as well as hospital quality raters such as US News and World Report and Leapfrog) must measure boarding and act on their findings.

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