Boarder Patrol: A Reform Policy for America’s Paralyzed Emergency Departments

The story is not new. America’s emergency departments (EDs) are frequently overcrowded, their ability to provide high quality emergency care compromised by lack of space and required attention to admitted patients boarding in the ED, awaiting a hospital bed upstairs. We first experienced ED boarding as residents where signouts were along the lines of: “Sixty-year-old male, sign-out of a sign-out, admitted, boarding for the past 48 hours, chest pain patient, I think.” To an ED resident, the problem was clear. Later, at a California Chapter of the American College of Emergency Physicians (Cal/ACEP) meeting, we were surprised when a visiting state representative, asked about her approach to ED boarding, replied, “What’s boarding?” We realized that many of our elected representatives, patients, and hospital leaders are not aware of the true cause of ED crowding. With the support of Cal/ACEP, we developed a short video to explain to the layperson what boarding is, its causes, consequences, and possible solutions (availble under “Supporting Material” of the article at http://escholarship.org/ uc/uciem_westjem).