Hospital ERs overflow with patients who have nowhere to go next

Recently, a lawmaker took me aside to share a story about a constituent who had a bad experience at a local hospital emergency room. The constituent waited for treatment in a department packed with patients everywhere including all the treatment bays, and even in the hallways.

The constituent had to wait way too long for that care.

Why the wait? If you’ve been to an emergency room lately, you may be asking the same thing.

Hospital emergency rooms frequently operate at or above their capacity depending on a host of factors. Flu season or multi-vehicle car accidents make numbers spike, for example. In some places, time of the day or week has an impact. Friday nights often are tough. Hospitals do a good job managing these unpredictable factors, but they do cause frustration.

However, one problem that increasingly pushes a hospital to capacity is sometimes known as “boarding” and it occurs when a patient could be discharged from the hospital, but needs additional care, and there’s no place for them to go.

Only a few years ago, we found that more than 90 percent of hospitals were unable to find timely placement for patients who needed long-term care after their hospital visit. More than half of Pennsylvania hospitals responding said that these delays happened many, many times in a year. Each year the calls for action on this grow.

How can that be? How is it possible that patients need to stay at hospitals because they don’t have a place to go?

These delays in discharge can happen because a frail older adult suffering from dementia—who also uses a ventilator—requires care in a facility with specially trained staff members who understand the person’s specific needs. Or, they happen because some people are dealing with mental health issues, as well as another condition, and they need to go to a facility that provides specialized care.

Searching for these types of facilities can be frustrating and all too often unsuccessful. Without a safe discharge plan, a patient must stay in the hospital. This delays the patient from receiving the additional care they need and, while they continue to stay at the hospital, it may delay other patients from receiving the life-saving care they need. One hospital leader told me recently that they have had up to 40 patients in this situation at one time.

Sometimes, the backlog gets so bad that the hospital is virtually shut down to new patients. That’s an outcome that’s unacceptable for patients, the community, and the hospital’s ability to fulfill its mission.

The solution to crowded hospital emergency rooms is not simply to add more hospital beds. We at the Hospital and Healthsystem Association of Pennsylvania believe that our communities need to work together to add new, or better coordinate existing community resources. We need to make sure that patients can connect to the care they need.

We need solutions to help patients get the care they need after they leave the hospital. These solutions will vary from place to place; one-size-fits-all remedies rarely work. Let’s give hospitals the tools they need to work with community partners to reduce this problem.

This is a conversation we will be initiating with government budget-writers and lawmakers during the coming months. We owe it to our patients to do all that we can to help them when they come through our doors…and when they leave.

Andy Carter is president and CEO of the Hospital and Healthsystem Association of Pennsylvania and a member of the Inquirer’s Health Advisory Panel.