Many Patients Avoid Going to EDs Because of Fear of Boarding, Delays
December 1, 2023 3 minutes read
By Stacey Kusterbeck
Even if patients have not been boarded in an ED hallway while waiting for an inpatient bed, they probably know someone who has. Fear of boarding in EDs “puts the entire healthcare system at risk for patients to distrust and lose faith in what should be a reliable source of help,” says Aisha Terry, MD, MPH, FACEP, president of the American College of Emergency Physicians (ACEP). Terry is an associate professor in the Department of Emergency Medicine at George Washington University School of Medicine and Health Sciences.
Almost half (43%) of adults would delay or avoid going to the ED if they knew that extreme delays associated with boarding were possible, according to a poll of more than 2,000 adults conducted by ACEP and Morning Consult.1 “The pandemic taught us a lot about what happens when people delay their care,” Terry notes.
During the early phases of the pandemic, EDs nationwide saw a significant decline in volume.2 “When ED volumes increased back up to normal levels, we saw people presenting with conditions that, if seen earlier, could have been managed more successfully in terms of improved outcomes,” Terry says.
The survey results suggest the same thing is happening now, only it is extreme delays that are keeping people away from EDs. For EDs, there are major patient safety concerns if people fear extreme delays to the point where they would avoid care. “If patients actually follow through on that, I anticipate we’ll see worse outcomes when they actually do come in, due to late presentations of advanced disease,” Terry warns.
What can EDs do to mitigate this risk? Terry says emergency physicians (EPs) should convey to patients that EDs are there for them, regardless of the boarding crisis. “Our job as emergency physicians is to stabilize and make sure that patients are not experiencing a life-threatening emergency and also manage their urgent conditions. We will continue to do that,” Terry says.
Patients always can expect to receive an initial evaluation and stabilization as required by the Emergency Medical Treatment and Labor Act (EMTALA). “But by virtue of deciding that they need to be admitted to the hospital, we are acknowledging that they need a higher level of care, that patient needs a higher ratio of caregivers, in terms of nursing staff and the like, that the ED just is not equipped to provide. But that doesn’t mean that we won’t do our part,” Terry says.
There is ample evidence suggesting ED boarding is dangerous for patients, and results in poor outcomes.3,4 The ACEP survey reveals an additional area of risk — patients may avoid EDs out of fear of boarding. “Delays in seeking emergency treatment can lead to worse outcomes for patients,” says Chadd K. Kraus, DO, DrPH, FACEP, vice chair of research and a practicing EP in the department of emergency and hospital medicine at Lehigh Valley Health Network in Allentown, PA.
EDs nationwide are seeing patients leave before completion of their evaluation due to long wait times, putting those patients at risk for poor outcomes. The ACEP survey points to a previously hidden area of risk — that a growing number of patients may put off coming to EDs in the first place, potentially until it is too late. “It is important for EDs to have the necessary resources to take care of all patients at all times so that care is not delayed,” Kraus says.
REFERENCES
1. American College of Emergency Physicians. New poll: Alarming number of patients would avoid emergency care because of boarding concerns. Oct. 5, 2023.
2. Lucero AD, Lee A, Hyun J, et al. Underutilization of the emergency department during the COVID-19 pandemic. West J Emerg Med 2020;21:15-23.
3. Kelen GD, Wolfe R, D’Onofrio G, et al. Emergency department crowding: The canary in the health care system. NEJM Catalyst. Sept. 28, 2021.
4. Sartini M, Carbone A, Demartini A, et al. Overcrowding in emergency department: Causes, consequences, and solutions-A narrative review. Healthcare (Basel) 2022;10:1625.
Emergency physicians should convey to patients that they will receive care, regardless of the boarding crisis. Stick to the foundation of emergency medical care: stabilize, ensure patients are not experiencing a life-threatening emergency, and manage their urgent conditions.
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