ED capacity issues nearing boiling point

Over the past months, health systems in numerous states have faced growing capacity challenges. That includes Boston-based Massachusetts General Hospital, which saw the highest level of patients boarded in the emergency department in its 200-year history.

Massachusetts has declared several regions "high risk" due to limited hospital capacity. On Jan. 11, Mass General reached a peak with 103 patients boarding in its emergency department, marking one of the most congested days in its history. ED boarding — when patients awaiting admission are held in the emergency department due to a lack of available inpatient beds — has been a persistent challenge for hospitals. 

In addition, an overwhelming majority of emergency department physicians across the country say they have experienced boarding times in their facilities exceeding 24 hours, according to a 2022 survey from the American College of Emergency Physicians. Discharge delays due to a lack of beds in nursing homes and other long-term care facilities are a key factor driving boarding challenges. Experts worry the problem may worsen if CMS funds for hospital-at-home programs dry up at the end of the year.

The growing crisis has been attributed to a number of factors, from hospital closures in the area to delays in increasing beds to a rising older population to limited facilities to transfer patients as more nursing facilities close.

In December, HHS Secretary Xavier Becerra tasked the Agency for Healthcare Research to convene a multistakeholder roundtable to determine  steps to combat hospital overcrowding. The roundtable is anticipated to be held within six months.

Here are other hospitals that have recently been struggling with ED boarding and overcrowding:

  1. Weymouth, Mass.-based South Shore Hospital is seeing record numbers of patients, with 360 people per day going into the emergency department for care in December.

  2. Two of Atlanta's hospitals — Grady Memorial Hospital and Emory University Hospital Midtown — are often listed as "severely" or "dangerously" overcrowded on a statewide hub used by EMS and hospitals for care coordination efforts.

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