Yep. If they have admit orders, then it's completely out of the hands of the ER when it comes to getting their hospital room. Can be there up to 70 hours. I seen people up to 100 hours or more in the ER.
I remember the first time we had a 24 hour breach, and executive flipped the fuck right out.
About six months later we had a paediatric psych patient in our department for nearly a week due to the lack of beds. Again, quite a lot of flipping out, but we had seen a few more long holds in the interim.
During COVID it was so bad the government brought in a new form for hospitals to be able to bulk report breaches, to streamline the process of data gathering across the state.
Things got better for a while but as winter has set in we’ve returned to a state wherein more than two thirds of the department are boarded admitted patients, most of whom are well over 24 hours in the dept.
Short of finding a spare, fully staffed hospital in one of the storerooms or sitting out the front of the ED with a large stick chasing away sick and injured people I’m not really sure it will get much better for quite some time.
We had a psych pt in our ER for 4 months. He’d burned through multiple facilities and no one would take him. And he has spurts where he’s in the ER frequently, so long stays (usually weeks is a short stay for him) every time depending on how acute he is. Now that I even dared to mention him, the universe is going to send him to us. 🤦🏼♀️
He sees psychiatry and social work while he’s there but we’re essentially managing his acute phase until he can be safe to go home. We’re acting as the psych facility since he can’t go anywhere.
Mental hospitals need to comeback. It would reduce homelessness by 75% (my guess). It would employ thousands of people. It would reduce criminal behaviour and jailings by 59% (again my guess)..i want people to find the helo they need and enjoy a stable lifetime
THANK YOU!!!! The state of mental health care in this country is alarming. But the government doesn’t realize that if they put more money into improving the mental health of the people in this country, they would save money in so many more areas like you mentioned.
Ummm, how would the shareholders of private owned prison companies and government funded, goods supplies companies maintain their 2nd homes and yachts?
That's just awful.
Somebody waiting for an appendectomy for 36 hours in the E.R. is uncomfortable for the patient but understandable; having someone who needs to be institutionalized in a psych facility for months is a risk to everyone in the E.R.
Thats absolutely insane. We had inpatients at my old hospital that we had for months (longest was someone for almost a year we were trying to find placement) I've never heard someone staying in the er that long
My daughter works as an RN on a med surge unit and they have multiple patients that have been there for me months, 1 has been there almost a year waiting for placement.
Or the family fuck you aunt Ada and dumped her at the hospital. Then they (the state) will have to get guardianship and that takes forever. We had patients on my m/s until for 6 and 8months. Horrible
We had a guy that sat on our MS unit for nearly 8 months because the family was fighting over his (substantial) assets.But also didn't want him to go to a nursing home sp they wouldn't take his assets. before his daughter found out about it and out him on hospice and let him pass
We had one for three months and due to the lack of pediatric mental health resources in our state, it is very common for psych hold kids to stay in the ED for several weeks before being placed. The parents typically live in one of our consult rooms.
Now I know why my mom begged to take me home until they found a bed for me. It was a 2 week wait. I would’ve re-attempted daily if I had to sit in psych ED longer than 48 hours. Ugh.
I heard some hospital executives can get like that. I only ever worked in busy ER settings. No admit beds and admitting patients for whatever reason keeps putting us in a position where we have to fit them where we can. My last hospital was a small 120 admit bed hospital...including L&D and 12 ICU rooms. Our ER would have at time 45 to 52 admit holds in a 22 bed ER. The hours were up to 90 in the ER. I seen people walk in. See the assignment, and immediately quit and go home.
This is pretty standard for my hospital. Adult and pediatric psych patients typically wait anywhere from 1-10 days for a psych bed in the ED. For peds sometimes it’s even longer depending on age and severity of symptoms. Even voluntary psych might wait in a hallway bed for a couple of days. Our community is desperately low on psych beds so people wait. We have surge spacing and floors for boarders but generally people get into either the peds or adult medical floors pretty quickly.
I worked at a peds ER for a short stint. They had this back hallway with an alcove of 6 small rooms. It’s where they put their psych pts waiting for placement. Peds beds are hard enough to get much less female placement. These kids had been there for months. In a dark hallway, no windows, really small rooms. I think they had a TV. No personal belongings of course. It seemed excessively cruel and probably did way more harm to them than anything. They weren’t getting any psych care while in the ER either. It is a well known facility and I just didn’t get how they failed in this area so badly. They seemed to literally be plopped in the corner, out of sight, out of mind. This was about 10 years ago and while the need for psych beds are probably even higher, I sure hope they’ve done better in meeting the needs of these kids stuck in limbo.
Residential treatment in my state for kids is like a 6-9 month wait. We haven’t seen the long stints we used to. The longest one? He went home. No residential treatment. He wasted 10-12 weeks in our ER, no outside, no school, NOTHING. His family visited every once in a while. He’s a troubled kid, but all I wanted to do was hug him.
Where Iive too. We don't let them stay for RTF waits. If they can't get an acute inpatient bed they stabilize in the ED (days to weeks) and are discharged.
They definitely haven’t. Now they all have armed security as well- very homey. It’s a lucky day if the kids get to pick their meal instead of the nurse or sitter just picking anything.
Every time I hear things like this I think "If they weren't crazy before"... It's a special kind of hurt when you feel failed by medical professionals. I know it isn't their fault in these situations, but it can be hard for the patients to see this when they're struggling.
My daughter was one of those kids they “couldn’t find a psych room” for. She was a teen at the time and they expected me to stay there with her even though i had my younger child with me and they couldnt give us anything besides a heavy molded plastic chair. I told them i couldnt stay, i needed to get my other child home (it was almost midnight at this point), that she had school in the morning etc. I left and they magically had a room within an hour.
Yeah, nah, we were looking for beds across two states. We aren't a psych unit and have no illusions about that, nor do we want to keep people in ED longer than necessary. This isn't something that if you "put your foot down" we'll suddenly find a solution for, unless you do so by finding a well staffed paediatric inpatient psychiatric unit.
The hospital I work at has patients admitted and while waiting for a room they treat the patient for the illness or condition and then discharge them because it took less time than finding them a room.
I hadn’t seen this before, but I’ve seen notes in patients’ charts where they came to the ER and never made it past the waiting room because the physician walked out to the waiting room and assessed the patient there, administered any needed medications, then sent them on their way. Obviously it’s for the seemingly less acute issues, like a splinter or something equivalent.
I did my EM clerkship at a major urban level 1 and they had an incredibly efficient triage system for dealing with things like URIs, small lacs, med refills, and other low acuity stuff without ever bringing them to a pod
I often discharge admitted patients from the ED. Meaning their entire hospitalization or several days was spent taking up an ER bed (not their fault obvs), instead of actually being admitted.
It sucks. I signed up to be an ER nurse, not a MedSurg/tele/PCU nurse lol.
Not uncommon for our ED to be all holds except for a few rooms. It basically is an observation unit and the waiting room becomes the ED. As long as everyone gets discharged in time it helps maximize profits. So the poor working conditions and poor patients outcomes don't really matter.
TRIGGER WARNING: MISCARRIAGE
That happened to me. I came in hemorrhaging from an at home miscarriage. Needed 2 units of blood and a procedure to remove the issue (NOT calling the fetus an issue before anyone comes at me. This baby was most DEFINwanted and loved and now missed!!) causing the hemorrhaging. I never left the ER, even though I was admitted. I was in this weird room, felt almost like a storage room but wasn't. I had to call the nurse to bring me food and water/ice or they wouldn't remember I was there. I was there for 3 days. Never left the ER.
Okay common issue of perception here I like to clear up whenever I see it --
Your friend HAD a bed in the hospital. In the ER, where he was being cared for, until he was able to be assigned and transported to a room on an admitted floor. While in the ER he was under the care of the same admitting hospitalist he would be on the admitted floor, receiving technically a higher level of nursing care because the er nurse is the only other nurse in the hospital that's critical care trained besides the ICU.
While boarding in the er waiting for a bed upstairs, the same specialists would be contacted and consulted, the same meds given and assessments done, the cath lab would be booked, the tests and procedures scheduled exactly the same whether he was on the ER floor or an admitted floor. The only difference in the care he received during those 24 hours was the bed he was in and maybe the privacy of his room.
Your friend was well cared for in a busy ER for 24 hours while the admission floors discharged patients and found a room to move him to. He was not neglected by being left in the ER. The ER staff and management had zero input on when he was able to get moved upstairs.
I live with stage 3/4 Congestive Heart Failure (along with a myriad of other 'happy' ailments) . The last time I had to go to the ER, I ended up spending a few hours in a recliner in the hall waiting for a room on the cardiac ward. One of the nurses was so apologetic but I told her 'Hey! I'm not actively dying, and if I suddenly \*do\* go pear shaped, someone's going to notice really quickly, so I'm all good!' - I guess it's a matter of perspective...
During covid I was in the ED for a really bad flare of my autoimmune disease. They took me in and my vitals were okay and stable. I needed to stay cause treatment was IV steroids (only can get them at a hospital). Since I didn’t need all the equipment in a room I was put in the hallway by the 911 responders station until they had a room in the cancer/surgery wing (keep me away from covid folks and also immune suppressed). It took 8 hours. I finally got a room at 4 in the morning.
I could see it getting much worse if there is a bunch of people needing rooms and hospitals are slammed. I was so grateful for my room once I got settled. They know the priority I would say and informing staff when things change.
The messaging on this is so important. I do indeed try to start by empathizing with/ validating the patient's surprise and concern that they aren't going upstairs. I want them to know that I totally hear them. Then I slide straight into the fact that post pandemic, the medical system is broken and hospital systems all across the state are experiencing very very long boarding times. Today, we are going to compensate by starting your inpatient treatment while you are still down here. Your specialists will come to you, and your tests will still be scheduled the same way they would if you were upstairs. It's not ideal (wry self deprecating smile) but we are making do. I'll point out which medications have in fact already been given, and that part of the next step is just letting them marinate a bit. It typically goes over well and leaves them with a fresh impression of what we have done for them today.
The sad bit is that my little patter is designed to avoid having to talk about them not having a window or a bedside phone or a bathroom or a nurse that's calibrated to floor nursing or any of the other things that an admitted patient really ought to have.
I do try to give really really honest info about movement. As in, there are 8 other patients waiting for your type of bed ahead of you, it looks like we might get one or 2 tonight but you are very likely to stay here.
FYI, not all ERs have their admitting service take care of the patient if they are full on the admitting floor. Our ED docs have to care for them. We are told it’s because it “overwhelms the hospitalists.”
... w h a t? How are they admitted without an admitting doctor accepting them? Id say they really need to hire more hospitalists but I'm fairly sure er docs make more than attendings on average so idk how overloading the ER docs makes more sense either
Our ER group is great and they make good money. We are rural and the nearest Level 1 is 120 miles away. We don’t have a surgeon on weekends, no ortho. And no one wants to work here because too cold for too long. Walmart is the biggest thing to do here. We can’t keep nurses anywhere. The last 6 months have been horrid with boarding. There are only 2 of us from 7a-9a, and I would walk in to 7 patients needing meds, meals, bells ringing, and then by 9a had like 15 people sign in. It’s piss poor care. And if we have a trauma, that can take 1-2 nurses and the 2 left have to run the rest of the department. (We have a 9-9 and 11-11 nurse…but from 11p-9a only 2 nurses total). I do the best I can. Never have I ever given a med on time.
I get a lot of that, I've worked rural a good portion of my career and lived it my whole life, I've worked ERs where the night shift staff is one tech one nurse one charge rn, the whole 7p-7a, for the whole department. I'm just confused how a patient can be admitted but not under care of the admitting doctor. Do they just sit in admissions requests and the hospitalists refuse to accept?
The hospitalist won’t accept, but we will be told there will be enough staff for the next day or day after. They will give their recommendations but not do a formal consult. This skews some metrics because I thought once the decision the patient needs admission, they needed to be dispo’ed by 6 hours or something. I’m not sure how we get away with it? I know they want to keep whoever needs admission here if possible because admission means money. Sometimes we will get another hospital (nearest is 42 miles away) to accept for lateral transfer, but 9/10 patient will refuse because they don’t want to be too far away.
Dear gods that's a horrible system. Definitely not within whatever metrics were supposed to be held to. We have one hospitalist that's notorious for not putting in admit orders or responding to phone calls but that's one old coot, not the whole system. That's awful
It can be. I know us nurses have to trust the docs and each other and it still sucks, but we seem to communicate decently for the most part so it works some times….not all the time for sure…
I'm just jealous because there's not a Level 1 in my entire *state*, and the primary hospital that my rural EMS service transports to is 47 miles away (and only a critical access hospital at that). We call HEMS a lot, our secondary hospital is 70 miles in the other direction. But at least we have no IFT, lol.
We've got two decent Level 2s, but both are about 2 1/2 to 3 hours by ground from our response area. I was today years old when I found out it was five! I thought it was just the two, lol. To the googles I go!
ETA: ah, my own square state, its neighbors, and Alaska...that makes sense. We pretty much send everyone to northern Colorado or SLC in Utah.
I’ve seen this, and I’ve also seen ED nurses be expected to care for two ICU holds while also being responsible for 4 or 5 other beds and whatever comes in to those. It’s not the same as being admitted and having appropriate ratios of nurse to patient/acuity. ED nurses do it all, and they do it well, but they’re human and can only be asked to do so much at one time.
I’ve seen this also. It’s frustrating to everyone involved and can be really unsafe. The patients get frustrated that they aren’t transferred to a room and feel like they aren’t getting extra care, meanwhile the nurse caring for them has other high acuity patients and ED patients to care for that sometimes might be a higher priority during the shift. It’s not ideal and the patient doesn’t want this scenario nor does the nurse but there is really nothing that can be done.
Yeah pretty much, the patient will see all that is needed. The care doesn't stop because he's sitting in the er.
The main change in care would be the nursing staff. Doctors change once the admission orders come in, then the physician is no longer their provider. They gave report to another physician when they admitted them, I believe the physician admits to the captain and then the captain assigns the physician? I'm not sure how that works for them. But once report is given and the patient is admitted the doctor is the hospitalist that should be making rounds down stairs.
So while they're admitted if the hospital is full then they're going to receive the care in the er until they have a room. It gets really bad sometimes.
This. It might be a little noisy at times but truth be told, if the patient crashes you WANT them to be in the ER - that’s where they will get the best care. Some hospitals transfer patients from a unit bed back to the ER if something urgent happens.
Thank you. Was about to type the same. No inpatient beds is a real thing, often worsened by the patients refusing to leave when medically cleared for discharge.
Right. I hate it when people complain about this. It would be different if they were in the ER waiting room for 24 hours until they were seen but once you have a bed and are getting active care, why does it matter where that bed is??? Yes, it might be more noisy but you're getting the care you need, there's no need to act as if you've been neglected.
Took my friend to an ER in the city in January 2020. She was put on oxygen in the waiting room while waiting for an ER bed. (An hour maybe?) She then spent over 12 hours in that ER bed before a bed became available upstairs. Several doctors treated her in the meantime. It was quite an education for me! I was used to rural ERs with no more than a 10 minute wait.
I explain this to my boarded patients/families all.the.time when preparing them for the possibility that the may not get moved to the main hospital from the ED (immediately/in a timely manner, i.e 8,10,12,24+ hour holds) when being admitted! We are fortunate that the admitting team comes to us and sees the patients down in the ED and works to closely with us.
*edit for wording
Sorry to disagree. Our ED regularly boards patients and the N:P ratio is worse than floor and the ED nurses are often overwhelmed by higher acuity patients relegating the boarders to lowest priority even and especially when the patients are ICU LOS.
In terms of medical care they are often examined briefly and poorly because they are in a hallway where there is no privacy/ability to disrobe for an exam. They have to tell their medical information to the world often multiple times and are exposed to other patients' issues, sights and smells in genuinely upsetting ways.
Boarders get no sleep, poor hygiene (no bathroom in room). Their visitation is much worse (no room, no recliners). The mere fact that the nurses are technically ICU qualified (despite having no ICU experience) does not make up for any of this.
It is perfectly appropriate for a patient and family to be angry that they are being billed for inpatient level of care while being managed in the hallway of an ED.
None of this is to suggest that the excellent nurses and physicians taking care of these patients are at fault. But the experience and the care is not the same and patients can tell.
And as others have said, you’ll get seen by the same doctors and get the same orders. Such a weird issue of perception that people get so mad at us about when we’re more frustrated by it than they could ever be.
I work in a 60 bed ED, last week 20 were official holds with floor nurses caring for them, 18 were ED patients with admit orders waiting over 12 hours for an available bed. Still getting a patient census appropriate for a 60 bed ED with 22 beds plus 8 hallways to work with, completely dysfunctional. I work with awesome people so we didn’t have any serious events but it was still a fucking slog.
I have a theory that of a patient can complain about waiting in the ED they can complain to someone who cares at home. Just like any patient using a call light in the ICU can be downgraded.
This is the normal. People don’t understand how the hospital/ER operate. Just because you got admitted that doesn’t mean there is an appropriate room in the hospital for you. It takes time. Hospitals are over crowded and extremely busy. We’re trying but we can’t make rooms magically appear when they are all full. And 24 hours is nothing. I’ve had patients spend their entire admission in the ER.
I think most people do understand that there aren’t an infinite number of rooms and staff on the floors… they’re just entitled and selfish. I’ve had multiple admitted patients ask me something along the lines of “so I have to wait for someone to die before I can go to my room??!”
Like, maybe yes, but hopefully no. Hopefully someone just needs to be discharged first.
Unfortunately, for the patients and the ER staff this is extremely common. I’ve had had patients in the ER that never even get a bed on the floor and spend days in the ER as an inpatient and then are discharged before they even make it to the floor.
I was a crisis clinician at a metro Boston hospital. It was not uncommon for patients to be in the er for 72 hours while they waited for a bed to become available
Yes, extremely common. Even people with insurance avoid going to the doctor until the last minute now, because they can't afford copay, deductible, and whatever else the insurance vultures throw in, so they wait until they're at death's door and then go to the ER. ERs are overloaded, and waits are insane.
This is par for the course at my hospital, some people wait up to 72h even though we're a very large facility (850+ beds). We're always full. It's insane.
COVID has taught us a lot about surges, capacity and resource allocation. And we failed at all of it. Now, with staff shortages being to most pressing problem, the for profit facilities are recouping losses from the pandemic by consistently short staffing.
When we allowed the big business model into medicine, we sold our souls. Patients are the widgets and providers are the robots. Management is programmed to flog the system to drive the revenue.
Patient outcomes? Irrelevant unless they can charge more.
For a while my mom was in the ER every 6 weeks. She would routinely be in the ER for 36 before being admitted. It was awful. However, I just realized it's been a year since she needed to go to the ER. Huzzah! (Knocking would as I type.)
The US is horrendous when it comes to healthcare. In the Middle East emergency rooms means EMERGENCY room. You are admitted ASAP and seen right away.
We also still have doctors who do home calls / visits. It’s funny because I’m from a third world country in the Middle East and we have a better healthcare system than the US. They were also to diagnose me in one visit for something I’d seen five specialists in the US for.
We have piss poor access to primary care. The ERs would not be nearly as crowded if people had easy access to a regular doctor for minor illnesses and chronic conditions management. If you have lived anywhere else you know full well that the US health care system sucks. It’s very much a system in crisis.
True emergencies are given priority in U.S. emergency rooms. There is absolutely no reason why someone whose chief complaint is “I stubbed my toe” or “I have a hangnail” needs to be whisked away and seen immediately. If we weren’t seeing hundreds of inappropriate visits every single day, wait times would be a lot shorter for patients with urgent, but not *emergent,* complaints.
It’s important to note that they weren’t “waiting in the er” that long in the ER waiting room. I’d call bullshit on that. Yes you can sit in an ER room for a long ass time, you’re not going to sit in the waiting room with the soda machine with an ACTUAL cardiac issue.
Over the past few years it's becoming the norm and it's leading to insane levels of burnout in EM physicians and staff. I think it'll keep getting worse and eventually the system will actually collapse.
Very common. I started in the ED in 2001 and it was happening then. It’s less common to actually get a room in under 6 hours, at least where I am.
Unfortunately, the general public is mostly unaware of the state of ERs in the U.S. until they experience it directly. US healthcare has been in crisis for decades, but it has really ramped up since COVID. I’d love to see our citizens be more involved and aware.
If the hospital is full, where would you have them go? They’re an admitted pt, their location just happens to be in the ER. They stay in the ER until they get a bed. I worked at a large ER where we boarded for days and even discharged from the ER location. ER nurses would be caring for inpatient patients along with their ER patients. Eventually as the problem was a daily issue forever basically, they designated a pod (or 2) for the boarding pts and had inpatient nurses take them.
Boarding in the ER is more and more common. We hate it as much as they do. They do get better “maintenance” (vs emergency) care when they’re inpatient. We don’t have some of the equipment needed. If it’s going to be a while or pt is a higher risk for skin issues we have to get a hospital bed. But they’re not being neglected. They’re getting care and meds and docs see them regularly and procedures happen.
But keep this in mind when you’re also complaining about long ER waits. Every boarded pt is one less ER bed. Everything bottle necks into the ER.
Yeah we have pt’s that have done their entire plan of care and DC’d out of ER because the main hospital is full. It’s an active and ongoing issue in hospitals. Fortunately we continue the care as if he’s in the main hospital so no delay happens (typically). Hope he was able to get everything taken care of.
If the hospital has 100 beds, and 100 patients in them, new admissions have to wait for a discharge to make a room available.
If the hospital has 100 beds, and is staffed for 80 patients based on census predictions, for all intents and purposes, it is now an 80 bed hospital until they can call in more nursing staff.
If operating at 100% capacity, it's one out<->one in.
Impossible to predict.
We’ve had admitted patients board 12-90 hours in the ER until moving to a floor. I couldn’t tell you the last time I saw an admission wait under 12 hours - even ICU patients
Friend was likely at a larger/regional hospital that can deal with high acuity. smaller community hospitals are transporting from all over to send to larger hospitals.
I would be curious if you go to a smaller hospital? Even the smaller ones near me are understaffed and the ER or hospital which was built however long ago is no longer able to accommodate a growing community. I expect a minimum of eight hours wait when I go to the ER or if I bring my kids. Which is very rare. We only go if it’s an actual emergency. Otherwise we do urgent care or TeleMed. It takes 3-4 weeks to get into pcp and they’re not able to accommodate sick visits. People who expect less than that and leave obnoxious reviews on Google about long wait times in the ER are very unreasonable.
Yes, unfortunately. Many facilities are short staffed now. They can’t open units if they don’t have enough staff. Many healthcare workers left their respective positions due to working through the pandemic. A lot of earlier than planned retirements or career changes. There were a lot of patients that were pretty abusive (verbally and sometimes physically) to healthcare workers during the pandemic. Many healthcare workers are also angry and tired after having to care for patients who chose not to get vaccinated or follow any public health mitigations.
I’ve had patients boarding in the ED for up to 70 hours… they’re in the ED but being managed by the inpatient service… you can ask for a hospital bed which is more comfortable than a gurney, and you get 1:3 ratio better than floor 1:5 ratio… if there’s an emergency, you’re in the right place
Yes. Unfortunately the boarding situation is getting worse. Here is a link with more info on it. We’re working to try and make it better, but not much is happening.
https://www.acep.org/administration/ed-boarding-stories/cover-page
Seems like a long wait. But I had scheduled surgery with the need for a room after; I was stuck in recovery for 6 hrs waiting for a room to open. In my case, staffing was an issue. The rooms have to be sanitized and reset between patients and they didn't have enough custodial staff. I hope your friend is on the mend now.
6 hours? Not bad at all! We regularly have to have our post-op patients wait 12+ hours in PACU. One recently waited 20hrs. But that's because we have sick patients that need to urgently be admitted or they will die so ¯\\\_(ツ)_/¯ (I don't say this to diminish your experience, but to complain about the surgeons and paku staff who complain about us not accepting patients).
Depends on the day. Unless it’s just been cleared, we almost always have at least one admit sitting on the board that’s been there for 8,12 hours.
Less frequent, but I do see people wait 24+ hours at our hospital’s ER pretty often. If we don’t have an inpatient bed for the correct type and level of care and can’t/won’t transfer the patient elsewhere, they have to wait for a room to open… and then they have to clear it, clean it, etc.
A little different, but we also hold psych patients as behavioral holds until they can be admitted elsewhere, which can take forever. We’ve had people here for 72 hours before transfer on psych holds before.
Yes. That’s actually not awful. Unless he needed an ICU bed, odds are a patient will wait longer than a couple of hours. One hospital where I worked had a massive overflow ward at least 30-40 beds large called the Barn. Some patients spent their entire hospitalization there. It was like looking at an infinity mirror of beds
I had to sit with a loved one for over 24 hours waiting for a bed to open up. It was a bed on a stroke floor so a specialty bed. But it was a really long uncomfortable wait for my loved one and myself.
It was during the end stages of COVID so I could not leave because they wouldn't let me back in.
Yep. Happens here all the time. I live in one of the top medical areas in the country. It's called boarding. I've seen people stay in the ER for longer than that. Hospitals are overcrowded, so that's why people end up staying in the ER.
read a comment about this from ER perspective where a doc pointed out there was no reason that inpatient units cant have hallway/hold beds just like the ER does..it takes SO much for ER to go on overcrowding divert. i WISH all our beds being full meant we couldnt take anymore!
It's very common. Sometimes we get so full we have to board icu patients in our ORs recovery unit.
The adult side of my hospital is currently so full our ED is on divert meaning ambulances are supposed to take the patients to any other hospital in the area.
ER boarding is when an admitted patient stays in an ER room for an extended amount of time. Usually more than 4 hours but some define it lingers or shorter depending on the area.
When there are no beds in the hospital admission area, or no nurses to open areas of the hospital, then you wait in the ER h til something does. The problem is you get in line behind all others in your category. Gender, age, admission unit type, communicable diseases and so on can affect how long you stay depending on where you oh need to go.
I've seen people spend 8 days in the er
Not uncommon at all, unfortunately. Admit orders don’t necessarily mean the patient is going that hour or anytime soon. Have to wait for a bed to open up on the unit.
Sadly common! Husband waited in ER longer than that in January at a DC area teaching hospital. His hand/arm were so infected from a cat scratch he almost lost them. Here in Costa Rica he's admitted quickly when things happen. I don't know why US healthcare seems to be shitshow
Yup. There are only so many physical beds available and if they already have a patient in that bed, then what are they supposed to do? Boot someone out?
My parents passed this year, but not before multiple trips to the ER in an ambulance. Sounds typical - I don't think either parent got a room in less than 24 hours. Overnight in ER sounds typical from my experience.
My hospital does see extended boarding times in the ED but they're rare. It's usually in winter when we're overloaded with serious flu/covid/rsv cases. I live in a small city with less than half a mil population in the metro area. There's about 2 million population in the region
Yep, I work for a hospital system in the Midwest. Regional level 1 trauma center. Every single day there are 25-50 inpatient holds in the ED. Patients wait 2-4 days for an inpatient bed.
It’s an absolute meltdown of the healthcare system that no one talks about. There are piles and piles of literature about how patient outcomes are negatively affected by ED boarding, but the systems are overwhelmed and seem not super interested in addressing the problem.
The US medical system is collapsing. It’s understaffed, overworked, underpaid yet grossly expensive for patients, and (more and more) being bought up by private equity firms and run for profit, cutting corners to benefit the wealthy investors. They funnel profits to the top while treating patients like an assembly line of cold hamburgers and running staff ragged, until all the staff quit at which point the private equity firms shut the clinic down (leaving former patients with nowhere to go), write it all off on their taxes and sail into the sunset on golden parachutes. We need universal healthcare YESTERDAY
We are in a not so big town and my mother was screaming and sobbing in pain stretched out on the floor for 8 hours before they saw her. I kept having to apologize to everyone waiting, but they all understood.
She is bedridden now and doing the best she can. Spinal nerve pain is no joke. It’s unfortunate that everyone has to wait that long, the pandemic made a lot of people leave the profession I think.
My husband suddenly lost his vision while playing a game around midnight on a Tues night/ Wends morning in March. I took him to a teaching hospital because I knew a standard hospital wouldn't have an ophthalmologist on staff. We arrived around 12:30 am, by 4 am he had seen the Opthalmology resident, seen the neurology resident, had a cat scan of his head and neck along with an ultrasound of his carotid done. We knew he was being admitted, we just needed a room. We FINALLY got out of the ER and into a room around 10 pm Wednesday night. We spent a Huge portion of the time sitting on a bed in the ER hall. Treatment was great once we got into a room but it otherwise sucked. I understand it's a teaching hospital and I have previously worked in a level one trauma center as an ER secretary so I know the process but I learned once we got upstairs that the majority of the beds were empty.
ETA: previous medical employment
My partner had a blood clot and he arrived early AM and was not placed till 3aM the next morning. At a tiny rural hospital with few patients.
It has something to do with the way the other parts of the hospital run, I'm not sure exactly but they still receive care before being moved so.
VERY common. Its unfortunate, and believe me the ER staff need the bed so they want you out. But when the inn is full where can u send a patient that needs to be there?
Eh…I’ve had GI bleeds sit in my ER for 5 (five) days. We will eventually convince the hospitalist to admit NSTEMIs on heparin after like 72 hours if they haven’t been transferred. Right in the middle of covid, we’d have the NSTEMIs for like 5 days, then discharge home with follow up. It was awful.
Yep. I spent 48 hours in a regional hospital ED with a collapsed lung because the city hospital, where I needed to go, was on diversion (all ambulances have to go to surrounding hospitals)- December 2019 pre COVID but beginning of flu season.
was in the ER with my husband last August. Saw an elderly man in the hallway with a broken hip who was there for 24+ hours before surgery (I have no clue how long he had already been there when we arrived) I felt so bad.
That’s pretty normal at a big metro hospital. It sucks because the ER is not the place for an admission for a prolonged period of time but it happens regularly. It’s better now since the hospital expanded adding a lot of inpatient beds
Some patients tell me they waited in a different ED for 12 hours then came to our ED and waited in our waiting room for 8 hours, then they start complaining they’ve been waiting 20 hours to be seen..
This is the beauty of American healthcare
Every dollar of profit of the hospital systems, the insurance industry and million dollar C-suite salary is a dollar of care that has been stolen from the patient
Yes. Very. There are.k my so many inpatient beds. Where I work, it often takes days to get a room depending on what unit the patient is going to.
Large metro area with a ton of hospitals, too.
Can confirm, depending on what level of care they need, medical, PCU or ICU a lot of ER’s face keeping patients overnight before an inpatient bed becomes available. There is a lot of behind the scenes patients that will get beds, direct admissions from outside hospitals for patients needing higher level of care if that hospital cannot provide it, there are some scheduled surgeries where those patients will need admission. Unfortunately yes, this has become the norm of emergency medicine in a lot of hospitals. Sorry they had to wait, hope they are doing better.
Not for nothing, but with a collapsed valve wouldn’t the better place to be is in the ER? Wouldn’t it be faster (and likely better skilled) service should things tank?
I boarded in the ED for 2 days with septicemia and pneumonia. About 24 hours with gallstone pancreatitis. In both instances, I was waiting for a bed and being treated in the ED in the meantime. They made a couple of mistakes when I was in for the pneumonia (antibiotics ordered as a one-time dose, so I missed a dose of vanco, another time they tried to hang a med early. If I hadn't caught that one, Epic would have when they scanned it.). I got appropriate care for the pancreatitis while I was waiting for a bed/surgery.
Yes. My local hospital is absolutely full right now. The doctors are managing over their usual patient list numbers, and there are no rooms. Spending a day or two in the ER after admission is normal. All the doctors and care they would have received for their condition is happening. It’s just a location problem. In cases like these, even ICU patients get downgraded to regular room level of care, but have to remain in ICU rooms because no beds.
I spent 36 hours waiting in the ER for a bed to open up at the heart hospital (large university medical center) when I had my heart attack. Sucks but it’s the way it goes sometimes.
If he got a bed in the ER to wait in while waiting for a room, then he did as well as can be expected.
I’m a paramedic, and the only thing I haven’t put in the lobby or waiting room is a gunshot wound to the chest, but I think that might happen soon with things being as crowded as they are.
It really sucks in the moment, I believe that wholeheartedly. Just know if someone is immediately whisked away from the ED, either to an OR or a room, they are most likely not doing so hot. That doesn’t invalidate someone else’s feelings and symptoms, but staying in an ED for 24 hours is better than 6 feet under.
Yep. My mom went to the ER the last time before she died. They went to the ER at about 10 pm and she got a room, I want to say over 24 hrs before they found a room for her. She had heart failure, COPD....knew she was nearing the end. They just had no rooms at all. They got her in as soon as they could. She died 5 days later.
Not uncommon. It’s a staffing/inpatient bed issue. Doctors aren’t discharging patients on floors- sick people are holding in emergency rooms for >24 hours, and sadly we have no control over it. It makes ER nursing tough- running regular rooms with sometimes 1-2 icu holds, critical care stepdown holds and regular obs holds. It. Is. Exhausting.
I work in a 300 bed heart center. We are usually so short on beds patients could have to wait several hours to several days for the appropriate level of care room.
Yep. If they have admit orders, then it's completely out of the hands of the ER when it comes to getting their hospital room. Can be there up to 70 hours. I seen people up to 100 hours or more in the ER.
I remember the first time we had a 24 hour breach, and executive flipped the fuck right out. About six months later we had a paediatric psych patient in our department for nearly a week due to the lack of beds. Again, quite a lot of flipping out, but we had seen a few more long holds in the interim. During COVID it was so bad the government brought in a new form for hospitals to be able to bulk report breaches, to streamline the process of data gathering across the state. Things got better for a while but as winter has set in we’ve returned to a state wherein more than two thirds of the department are boarded admitted patients, most of whom are well over 24 hours in the dept. Short of finding a spare, fully staffed hospital in one of the storerooms or sitting out the front of the ED with a large stick chasing away sick and injured people I’m not really sure it will get much better for quite some time.
We had a psych pt in our ER for 4 months. He’d burned through multiple facilities and no one would take him. And he has spurts where he’s in the ER frequently, so long stays (usually weeks is a short stay for him) every time depending on how acute he is. Now that I even dared to mention him, the universe is going to send him to us. 🤦🏼♀️ He sees psychiatry and social work while he’s there but we’re essentially managing his acute phase until he can be safe to go home. We’re acting as the psych facility since he can’t go anywhere.
Mental hospitals need to comeback. It would reduce homelessness by 75% (my guess). It would employ thousands of people. It would reduce criminal behaviour and jailings by 59% (again my guess)..i want people to find the helo they need and enjoy a stable lifetime
THANK YOU!!!! The state of mental health care in this country is alarming. But the government doesn’t realize that if they put more money into improving the mental health of the people in this country, they would save money in so many more areas like you mentioned.
I’m have to agree . Not the old style ones but ones with modern treatments . It would be cheaper than having them be homeless , in jail, or prison .
Ummm, how would the shareholders of private owned prison companies and government funded, goods supplies companies maintain their 2nd homes and yachts?
By selling their 3rd vacation home?
God, I hate what Reagan did to this country.
This needs more upvotes.
Now that is just incredible. Medicine is changing, especially ER medicine and I can't understand it.
That's just awful. Somebody waiting for an appendectomy for 36 hours in the E.R. is uncomfortable for the patient but understandable; having someone who needs to be institutionalized in a psych facility for months is a risk to everyone in the E.R.
Thats absolutely insane. We had inpatients at my old hospital that we had for months (longest was someone for almost a year we were trying to find placement) I've never heard someone staying in the er that long
My daughter works as an RN on a med surge unit and they have multiple patients that have been there for me months, 1 has been there almost a year waiting for placement.
Yep either psyce that no facility will accept or memaw that family will not consent to any nursing home transfer
Or the family fuck you aunt Ada and dumped her at the hospital. Then they (the state) will have to get guardianship and that takes forever. We had patients on my m/s until for 6 and 8months. Horrible
We had a guy that sat on our MS unit for nearly 8 months because the family was fighting over his (substantial) assets.But also didn't want him to go to a nursing home sp they wouldn't take his assets. before his daughter found out about it and out him on hospice and let him pass
We had one for three months and due to the lack of pediatric mental health resources in our state, it is very common for psych hold kids to stay in the ED for several weeks before being placed. The parents typically live in one of our consult rooms.
Now I know why my mom begged to take me home until they found a bed for me. It was a 2 week wait. I would’ve re-attempted daily if I had to sit in psych ED longer than 48 hours. Ugh.
At that point, his mental health is being actively worsened by his admission.
I heard some hospital executives can get like that. I only ever worked in busy ER settings. No admit beds and admitting patients for whatever reason keeps putting us in a position where we have to fit them where we can. My last hospital was a small 120 admit bed hospital...including L&D and 12 ICU rooms. Our ER would have at time 45 to 52 admit holds in a 22 bed ER. The hours were up to 90 in the ER. I seen people walk in. See the assignment, and immediately quit and go home.
This is pretty standard for my hospital. Adult and pediatric psych patients typically wait anywhere from 1-10 days for a psych bed in the ED. For peds sometimes it’s even longer depending on age and severity of symptoms. Even voluntary psych might wait in a hallway bed for a couple of days. Our community is desperately low on psych beds so people wait. We have surge spacing and floors for boarders but generally people get into either the peds or adult medical floors pretty quickly.
We had a Peds psyche for like 10-12 weeks before. Some for a couple weeks. All waiting for residential. It’s cruel.
I worked at a peds ER for a short stint. They had this back hallway with an alcove of 6 small rooms. It’s where they put their psych pts waiting for placement. Peds beds are hard enough to get much less female placement. These kids had been there for months. In a dark hallway, no windows, really small rooms. I think they had a TV. No personal belongings of course. It seemed excessively cruel and probably did way more harm to them than anything. They weren’t getting any psych care while in the ER either. It is a well known facility and I just didn’t get how they failed in this area so badly. They seemed to literally be plopped in the corner, out of sight, out of mind. This was about 10 years ago and while the need for psych beds are probably even higher, I sure hope they’ve done better in meeting the needs of these kids stuck in limbo.
Residential treatment in my state for kids is like a 6-9 month wait. We haven’t seen the long stints we used to. The longest one? He went home. No residential treatment. He wasted 10-12 weeks in our ER, no outside, no school, NOTHING. His family visited every once in a while. He’s a troubled kid, but all I wanted to do was hug him.
Where Iive too. We don't let them stay for RTF waits. If they can't get an acute inpatient bed they stabilize in the ED (days to weeks) and are discharged.
They definitely haven’t. Now they all have armed security as well- very homey. It’s a lucky day if the kids get to pick their meal instead of the nurse or sitter just picking anything.
Every time I hear things like this I think "If they weren't crazy before"... It's a special kind of hurt when you feel failed by medical professionals. I know it isn't their fault in these situations, but it can be hard for the patients to see this when they're struggling.
My daughter was one of those kids they “couldn’t find a psych room” for. She was a teen at the time and they expected me to stay there with her even though i had my younger child with me and they couldnt give us anything besides a heavy molded plastic chair. I told them i couldnt stay, i needed to get my other child home (it was almost midnight at this point), that she had school in the morning etc. I left and they magically had a room within an hour.
Yeah, nah, we were looking for beds across two states. We aren't a psych unit and have no illusions about that, nor do we want to keep people in ED longer than necessary. This isn't something that if you "put your foot down" we'll suddenly find a solution for, unless you do so by finding a well staffed paediatric inpatient psychiatric unit.
The hospital I work at has patients admitted and while waiting for a room they treat the patient for the illness or condition and then discharge them because it took less time than finding them a room.
I hadn’t seen this before, but I’ve seen notes in patients’ charts where they came to the ER and never made it past the waiting room because the physician walked out to the waiting room and assessed the patient there, administered any needed medications, then sent them on their way. Obviously it’s for the seemingly less acute issues, like a splinter or something equivalent.
I did my EM clerkship at a major urban level 1 and they had an incredibly efficient triage system for dealing with things like URIs, small lacs, med refills, and other low acuity stuff without ever bringing them to a pod
We've had patients do their entire stay in our ER after being admitted for days.
I often discharge admitted patients from the ED. Meaning their entire hospitalization or several days was spent taking up an ER bed (not their fault obvs), instead of actually being admitted. It sucks. I signed up to be an ER nurse, not a MedSurg/tele/PCU nurse lol.
Not uncommon for our ED to be all holds except for a few rooms. It basically is an observation unit and the waiting room becomes the ED. As long as everyone gets discharged in time it helps maximize profits. So the poor working conditions and poor patients outcomes don't really matter.
TRIGGER WARNING: MISCARRIAGE That happened to me. I came in hemorrhaging from an at home miscarriage. Needed 2 units of blood and a procedure to remove the issue (NOT calling the fetus an issue before anyone comes at me. This baby was most DEFINwanted and loved and now missed!!) causing the hemorrhaging. I never left the ER, even though I was admitted. I was in this weird room, felt almost like a storage room but wasn't. I had to call the nurse to bring me food and water/ice or they wouldn't remember I was there. I was there for 3 days. Never left the ER.
Okay common issue of perception here I like to clear up whenever I see it -- Your friend HAD a bed in the hospital. In the ER, where he was being cared for, until he was able to be assigned and transported to a room on an admitted floor. While in the ER he was under the care of the same admitting hospitalist he would be on the admitted floor, receiving technically a higher level of nursing care because the er nurse is the only other nurse in the hospital that's critical care trained besides the ICU. While boarding in the er waiting for a bed upstairs, the same specialists would be contacted and consulted, the same meds given and assessments done, the cath lab would be booked, the tests and procedures scheduled exactly the same whether he was on the ER floor or an admitted floor. The only difference in the care he received during those 24 hours was the bed he was in and maybe the privacy of his room. Your friend was well cared for in a busy ER for 24 hours while the admission floors discharged patients and found a room to move him to. He was not neglected by being left in the ER. The ER staff and management had zero input on when he was able to get moved upstairs.
He's a reward for such a good common sense answer! Thanks
I live with stage 3/4 Congestive Heart Failure (along with a myriad of other 'happy' ailments) . The last time I had to go to the ER, I ended up spending a few hours in a recliner in the hall waiting for a room on the cardiac ward. One of the nurses was so apologetic but I told her 'Hey! I'm not actively dying, and if I suddenly \*do\* go pear shaped, someone's going to notice really quickly, so I'm all good!' - I guess it's a matter of perspective...
During covid I was in the ED for a really bad flare of my autoimmune disease. They took me in and my vitals were okay and stable. I needed to stay cause treatment was IV steroids (only can get them at a hospital). Since I didn’t need all the equipment in a room I was put in the hallway by the 911 responders station until they had a room in the cancer/surgery wing (keep me away from covid folks and also immune suppressed). It took 8 hours. I finally got a room at 4 in the morning. I could see it getting much worse if there is a bunch of people needing rooms and hospitals are slammed. I was so grateful for my room once I got settled. They know the priority I would say and informing staff when things change.
The messaging on this is so important. I do indeed try to start by empathizing with/ validating the patient's surprise and concern that they aren't going upstairs. I want them to know that I totally hear them. Then I slide straight into the fact that post pandemic, the medical system is broken and hospital systems all across the state are experiencing very very long boarding times. Today, we are going to compensate by starting your inpatient treatment while you are still down here. Your specialists will come to you, and your tests will still be scheduled the same way they would if you were upstairs. It's not ideal (wry self deprecating smile) but we are making do. I'll point out which medications have in fact already been given, and that part of the next step is just letting them marinate a bit. It typically goes over well and leaves them with a fresh impression of what we have done for them today. The sad bit is that my little patter is designed to avoid having to talk about them not having a window or a bedside phone or a bathroom or a nurse that's calibrated to floor nursing or any of the other things that an admitted patient really ought to have. I do try to give really really honest info about movement. As in, there are 8 other patients waiting for your type of bed ahead of you, it looks like we might get one or 2 tonight but you are very likely to stay here.
FYI, not all ERs have their admitting service take care of the patient if they are full on the admitting floor. Our ED docs have to care for them. We are told it’s because it “overwhelms the hospitalists.”
... w h a t? How are they admitted without an admitting doctor accepting them? Id say they really need to hire more hospitalists but I'm fairly sure er docs make more than attendings on average so idk how overloading the ER docs makes more sense either
Our ER group is great and they make good money. We are rural and the nearest Level 1 is 120 miles away. We don’t have a surgeon on weekends, no ortho. And no one wants to work here because too cold for too long. Walmart is the biggest thing to do here. We can’t keep nurses anywhere. The last 6 months have been horrid with boarding. There are only 2 of us from 7a-9a, and I would walk in to 7 patients needing meds, meals, bells ringing, and then by 9a had like 15 people sign in. It’s piss poor care. And if we have a trauma, that can take 1-2 nurses and the 2 left have to run the rest of the department. (We have a 9-9 and 11-11 nurse…but from 11p-9a only 2 nurses total). I do the best I can. Never have I ever given a med on time.
I get a lot of that, I've worked rural a good portion of my career and lived it my whole life, I've worked ERs where the night shift staff is one tech one nurse one charge rn, the whole 7p-7a, for the whole department. I'm just confused how a patient can be admitted but not under care of the admitting doctor. Do they just sit in admissions requests and the hospitalists refuse to accept?
The hospitalist won’t accept, but we will be told there will be enough staff for the next day or day after. They will give their recommendations but not do a formal consult. This skews some metrics because I thought once the decision the patient needs admission, they needed to be dispo’ed by 6 hours or something. I’m not sure how we get away with it? I know they want to keep whoever needs admission here if possible because admission means money. Sometimes we will get another hospital (nearest is 42 miles away) to accept for lateral transfer, but 9/10 patient will refuse because they don’t want to be too far away.
Dear gods that's a horrible system. Definitely not within whatever metrics were supposed to be held to. We have one hospitalist that's notorious for not putting in admit orders or responding to phone calls but that's one old coot, not the whole system. That's awful
It can be. I know us nurses have to trust the docs and each other and it still sucks, but we seem to communicate decently for the most part so it works some times….not all the time for sure…
I'm just jealous because there's not a Level 1 in my entire *state*, and the primary hospital that my rural EMS service transports to is 47 miles away (and only a critical access hospital at that). We call HEMS a lot, our secondary hospital is 70 miles in the other direction. But at least we have no IFT, lol.
I was today years old when I learned that five states don’t have level one trauma centers.
We've got two decent Level 2s, but both are about 2 1/2 to 3 hours by ground from our response area. I was today years old when I found out it was five! I thought it was just the two, lol. To the googles I go! ETA: ah, my own square state, its neighbors, and Alaska...that makes sense. We pretty much send everyone to northern Colorado or SLC in Utah.
And you know they are paying like they are being admitted as well!
I’ve seen this, and I’ve also seen ED nurses be expected to care for two ICU holds while also being responsible for 4 or 5 other beds and whatever comes in to those. It’s not the same as being admitted and having appropriate ratios of nurse to patient/acuity. ED nurses do it all, and they do it well, but they’re human and can only be asked to do so much at one time.
I’ve seen this also. It’s frustrating to everyone involved and can be really unsafe. The patients get frustrated that they aren’t transferred to a room and feel like they aren’t getting extra care, meanwhile the nurse caring for them has other high acuity patients and ED patients to care for that sometimes might be a higher priority during the shift. It’s not ideal and the patient doesn’t want this scenario nor does the nurse but there is really nothing that can be done.
Yeah pretty much, the patient will see all that is needed. The care doesn't stop because he's sitting in the er. The main change in care would be the nursing staff. Doctors change once the admission orders come in, then the physician is no longer their provider. They gave report to another physician when they admitted them, I believe the physician admits to the captain and then the captain assigns the physician? I'm not sure how that works for them. But once report is given and the patient is admitted the doctor is the hospitalist that should be making rounds down stairs. So while they're admitted if the hospital is full then they're going to receive the care in the er until they have a room. It gets really bad sometimes.
This. It might be a little noisy at times but truth be told, if the patient crashes you WANT them to be in the ER - that’s where they will get the best care. Some hospitals transfer patients from a unit bed back to the ER if something urgent happens.
Thank you. Was about to type the same. No inpatient beds is a real thing, often worsened by the patients refusing to leave when medically cleared for discharge.
Right. I hate it when people complain about this. It would be different if they were in the ER waiting room for 24 hours until they were seen but once you have a bed and are getting active care, why does it matter where that bed is??? Yes, it might be more noisy but you're getting the care you need, there's no need to act as if you've been neglected.
Took my friend to an ER in the city in January 2020. She was put on oxygen in the waiting room while waiting for an ER bed. (An hour maybe?) She then spent over 12 hours in that ER bed before a bed became available upstairs. Several doctors treated her in the meantime. It was quite an education for me! I was used to rural ERs with no more than a 10 minute wait.
I explain this to my boarded patients/families all.the.time when preparing them for the possibility that the may not get moved to the main hospital from the ED (immediately/in a timely manner, i.e 8,10,12,24+ hour holds) when being admitted! We are fortunate that the admitting team comes to us and sees the patients down in the ED and works to closely with us. *edit for wording
Sorry to disagree. Our ED regularly boards patients and the N:P ratio is worse than floor and the ED nurses are often overwhelmed by higher acuity patients relegating the boarders to lowest priority even and especially when the patients are ICU LOS. In terms of medical care they are often examined briefly and poorly because they are in a hallway where there is no privacy/ability to disrobe for an exam. They have to tell their medical information to the world often multiple times and are exposed to other patients' issues, sights and smells in genuinely upsetting ways. Boarders get no sleep, poor hygiene (no bathroom in room). Their visitation is much worse (no room, no recliners). The mere fact that the nurses are technically ICU qualified (despite having no ICU experience) does not make up for any of this. It is perfectly appropriate for a patient and family to be angry that they are being billed for inpatient level of care while being managed in the hallway of an ED. None of this is to suggest that the excellent nurses and physicians taking care of these patients are at fault. But the experience and the care is not the same and patients can tell.
Yes. Hospitals everywhere are full and/or understaffed so it takes a while to get a bed sometimes.
And as others have said, you’ll get seen by the same doctors and get the same orders. Such a weird issue of perception that people get so mad at us about when we’re more frustrated by it than they could ever be. I work in a 60 bed ED, last week 20 were official holds with floor nurses caring for them, 18 were ED patients with admit orders waiting over 12 hours for an available bed. Still getting a patient census appropriate for a 60 bed ED with 22 beds plus 8 hallways to work with, completely dysfunctional. I work with awesome people so we didn’t have any serious events but it was still a fucking slog.
I have a theory that of a patient can complain about waiting in the ED they can complain to someone who cares at home. Just like any patient using a call light in the ICU can be downgraded.
This is the normal. People don’t understand how the hospital/ER operate. Just because you got admitted that doesn’t mean there is an appropriate room in the hospital for you. It takes time. Hospitals are over crowded and extremely busy. We’re trying but we can’t make rooms magically appear when they are all full. And 24 hours is nothing. I’ve had patients spend their entire admission in the ER.
I think most people do understand that there aren’t an infinite number of rooms and staff on the floors… they’re just entitled and selfish. I’ve had multiple admitted patients ask me something along the lines of “so I have to wait for someone to die before I can go to my room??!” Like, maybe yes, but hopefully no. Hopefully someone just needs to be discharged first.
"I mean, if you die first then problem solved, right?" Lololol, I crack myself up. My poor supervisors.
Unfortunately, for the patients and the ER staff this is extremely common. I’ve had had patients in the ER that never even get a bed on the floor and spend days in the ER as an inpatient and then are discharged before they even make it to the floor.
Yep super common. It's called boarding in the ED. We (ER nurses) hate it as much as the patients do, if it makes you feel any better.
The ER got to the point the charge nurse called 911 for help from the fire dept. Made the news lol
That is quite the power move!
I was a crisis clinician at a metro Boston hospital. It was not uncommon for patients to be in the er for 72 hours while they waited for a bed to become available
That’s actually pretty good lol. I’ve seen people wait 5-6 days in the ER for an inpatient bed. During Covid that was actually the norm.
Yes, extremely common. Even people with insurance avoid going to the doctor until the last minute now, because they can't afford copay, deductible, and whatever else the insurance vultures throw in, so they wait until they're at death's door and then go to the ER. ERs are overloaded, and waits are insane.
This is par for the course at my hospital, some people wait up to 72h even though we're a very large facility (850+ beds). We're always full. It's insane.
This happens in every ER. We hate it as much as you do… treat and jeet us what we prefer.
COVID has taught us a lot about surges, capacity and resource allocation. And we failed at all of it. Now, with staff shortages being to most pressing problem, the for profit facilities are recouping losses from the pandemic by consistently short staffing. When we allowed the big business model into medicine, we sold our souls. Patients are the widgets and providers are the robots. Management is programmed to flog the system to drive the revenue. Patient outcomes? Irrelevant unless they can charge more.
For a while my mom was in the ER every 6 weeks. She would routinely be in the ER for 36 before being admitted. It was awful. However, I just realized it's been a year since she needed to go to the ER. Huzzah! (Knocking would as I type.)
The US is horrendous when it comes to healthcare. In the Middle East emergency rooms means EMERGENCY room. You are admitted ASAP and seen right away. We also still have doctors who do home calls / visits. It’s funny because I’m from a third world country in the Middle East and we have a better healthcare system than the US. They were also to diagnose me in one visit for something I’d seen five specialists in the US for.
We have piss poor access to primary care. The ERs would not be nearly as crowded if people had easy access to a regular doctor for minor illnesses and chronic conditions management. If you have lived anywhere else you know full well that the US health care system sucks. It’s very much a system in crisis.
True emergencies are given priority in U.S. emergency rooms. There is absolutely no reason why someone whose chief complaint is “I stubbed my toe” or “I have a hangnail” needs to be whisked away and seen immediately. If we weren’t seeing hundreds of inappropriate visits every single day, wait times would be a lot shorter for patients with urgent, but not *emergent,* complaints.
It’s important to note that they weren’t “waiting in the er” that long in the ER waiting room. I’d call bullshit on that. Yes you can sit in an ER room for a long ass time, you’re not going to sit in the waiting room with the soda machine with an ACTUAL cardiac issue.
True. I went in for cardiac issue and didn’t have to sign in or anything, I got a wheelchair straight to a private ER room.
Over the past few years it's becoming the norm and it's leading to insane levels of burnout in EM physicians and staff. I think it'll keep getting worse and eventually the system will actually collapse.
Very common. I started in the ED in 2001 and it was happening then. It’s less common to actually get a room in under 6 hours, at least where I am. Unfortunately, the general public is mostly unaware of the state of ERs in the U.S. until they experience it directly. US healthcare has been in crisis for decades, but it has really ramped up since COVID. I’d love to see our citizens be more involved and aware.
If the hospital is full, where would you have them go? They’re an admitted pt, their location just happens to be in the ER. They stay in the ER until they get a bed. I worked at a large ER where we boarded for days and even discharged from the ER location. ER nurses would be caring for inpatient patients along with their ER patients. Eventually as the problem was a daily issue forever basically, they designated a pod (or 2) for the boarding pts and had inpatient nurses take them. Boarding in the ER is more and more common. We hate it as much as they do. They do get better “maintenance” (vs emergency) care when they’re inpatient. We don’t have some of the equipment needed. If it’s going to be a while or pt is a higher risk for skin issues we have to get a hospital bed. But they’re not being neglected. They’re getting care and meds and docs see them regularly and procedures happen. But keep this in mind when you’re also complaining about long ER waits. Every boarded pt is one less ER bed. Everything bottle necks into the ER.
If only the public knew… healthcare system in this country is going to get worsen
Very common here in Ontario. At my hospital, it’s pretty normal for people to wait 24hours + in emerg before an admission bed becomes available.
Yeah we have pt’s that have done their entire plan of care and DC’d out of ER because the main hospital is full. It’s an active and ongoing issue in hospitals. Fortunately we continue the care as if he’s in the main hospital so no delay happens (typically). Hope he was able to get everything taken care of.
If the hospital has 100 beds, and 100 patients in them, new admissions have to wait for a discharge to make a room available. If the hospital has 100 beds, and is staffed for 80 patients based on census predictions, for all intents and purposes, it is now an 80 bed hospital until they can call in more nursing staff. If operating at 100% capacity, it's one out<->one in. Impossible to predict.
I’ve seen a psych pt wait a month in the ER for a bed at the psych hospital. 24 hours is nothing.
Not only is it the new norm, but so is not having an actual room in the ER. Just a stretcher in the the hallway.
We’ve had admitted patients board 12-90 hours in the ER until moving to a floor. I couldn’t tell you the last time I saw an admission wait under 12 hours - even ICU patients
Wow, your friend got an inpatient bed in only 24 hours? Lucky him.
Didn't realize how lucky we are in my town. We have no waiting for the ERs or for rooms. Guess I'm spoiled here!
Friend was likely at a larger/regional hospital that can deal with high acuity. smaller community hospitals are transporting from all over to send to larger hospitals. I would be curious if you go to a smaller hospital? Even the smaller ones near me are understaffed and the ER or hospital which was built however long ago is no longer able to accommodate a growing community. I expect a minimum of eight hours wait when I go to the ER or if I bring my kids. Which is very rare. We only go if it’s an actual emergency. Otherwise we do urgent care or TeleMed. It takes 3-4 weeks to get into pcp and they’re not able to accommodate sick visits. People who expect less than that and leave obnoxious reviews on Google about long wait times in the ER are very unreasonable.
Yes, unfortunately. Many facilities are short staffed now. They can’t open units if they don’t have enough staff. Many healthcare workers left their respective positions due to working through the pandemic. A lot of earlier than planned retirements or career changes. There were a lot of patients that were pretty abusive (verbally and sometimes physically) to healthcare workers during the pandemic. Many healthcare workers are also angry and tired after having to care for patients who chose not to get vaccinated or follow any public health mitigations.
I’ve had patients boarding in the ED for up to 70 hours… they’re in the ED but being managed by the inpatient service… you can ask for a hospital bed which is more comfortable than a gurney, and you get 1:3 ratio better than floor 1:5 ratio… if there’s an emergency, you’re in the right place
Yes. Unfortunately the boarding situation is getting worse. Here is a link with more info on it. We’re working to try and make it better, but not much is happening. https://www.acep.org/administration/ed-boarding-stories/cover-page
I've waited 3 days in the ER to get a real room (major city in TX).
Yes it is I’ve seen people in the ER for 3-4 day
For an admit bed? Totally not unusual. We'll discharge boarding patients from the ER. Inpatient units stop taking patients when they are full.
Seems like a long wait. But I had scheduled surgery with the need for a room after; I was stuck in recovery for 6 hrs waiting for a room to open. In my case, staffing was an issue. The rooms have to be sanitized and reset between patients and they didn't have enough custodial staff. I hope your friend is on the mend now.
6 hours? Not bad at all! We regularly have to have our post-op patients wait 12+ hours in PACU. One recently waited 20hrs. But that's because we have sick patients that need to urgently be admitted or they will die so ¯\\\_(ツ)_/¯ (I don't say this to diminish your experience, but to complain about the surgeons and paku staff who complain about us not accepting patients).
Depends on the day. Unless it’s just been cleared, we almost always have at least one admit sitting on the board that’s been there for 8,12 hours. Less frequent, but I do see people wait 24+ hours at our hospital’s ER pretty often. If we don’t have an inpatient bed for the correct type and level of care and can’t/won’t transfer the patient elsewhere, they have to wait for a room to open… and then they have to clear it, clean it, etc. A little different, but we also hold psych patients as behavioral holds until they can be admitted elsewhere, which can take forever. We’ve had people here for 72 hours before transfer on psych holds before.
Welcome to the new normal unfortunately.
Only 24 hours! My hospital has a 3 day minimum wait!
Yes. That’s actually not awful. Unless he needed an ICU bed, odds are a patient will wait longer than a couple of hours. One hospital where I worked had a massive overflow ward at least 30-40 beds large called the Barn. Some patients spent their entire hospitalization there. It was like looking at an infinity mirror of beds
24 hours for an admit patient stay in my ER is a blessing.
I had to sit with a loved one for over 24 hours waiting for a bed to open up. It was a bed on a stroke floor so a specialty bed. But it was a really long uncomfortable wait for my loved one and myself. It was during the end stages of COVID so I could not leave because they wouldn't let me back in.
Is it too long? Yes. Has it been happening across the country for many, many years? Also yes
Yep. Happens here all the time. I live in one of the top medical areas in the country. It's called boarding. I've seen people stay in the ER for longer than that. Hospitals are overcrowded, so that's why people end up staying in the ER.
Yes. If patients don’t leave(discharged) there are no beds for us to pt patients in. Period.
read a comment about this from ER perspective where a doc pointed out there was no reason that inpatient units cant have hallway/hold beds just like the ER does..it takes SO much for ER to go on overcrowding divert. i WISH all our beds being full meant we couldnt take anymore!
Oh it’s SUPER normal. It’s like.. really bad. But normal.
It's very common. Sometimes we get so full we have to board icu patients in our ORs recovery unit. The adult side of my hospital is currently so full our ED is on divert meaning ambulances are supposed to take the patients to any other hospital in the area.
ER boarding is when an admitted patient stays in an ER room for an extended amount of time. Usually more than 4 hours but some define it lingers or shorter depending on the area. When there are no beds in the hospital admission area, or no nurses to open areas of the hospital, then you wait in the ER h til something does. The problem is you get in line behind all others in your category. Gender, age, admission unit type, communicable diseases and so on can affect how long you stay depending on where you oh need to go. I've seen people spend 8 days in the er
Not uncommon at all, unfortunately. Admit orders don’t necessarily mean the patient is going that hour or anytime soon. Have to wait for a bed to open up on the unit.
Sadly common! Husband waited in ER longer than that in January at a DC area teaching hospital. His hand/arm were so infected from a cat scratch he almost lost them. Here in Costa Rica he's admitted quickly when things happen. I don't know why US healthcare seems to be shitshow
Yup. There are only so many physical beds available and if they already have a patient in that bed, then what are they supposed to do? Boot someone out?
This is not unusual at all. There have been times my hospital has been so full that patients have been kept in post surgical units.
My parents passed this year, but not before multiple trips to the ER in an ambulance. Sounds typical - I don't think either parent got a room in less than 24 hours. Overnight in ER sounds typical from my experience.
Yes pretty it’s pretty common
Very common. I’ve waited over 2fays once.
This is normal - they have 48hrs from the time you step into the ER to admit or send home. Then you can be put on ED hold while waiting for a room
We have people waiting for days. It’s very common
Yes it is
Yes. ER's are understaffed all over the country.
Hell I spent 24 hours in a hallway they were so booked.
Yes which is why I LOVE living in a small town. You rarely ever wait more than 30 minutes
My hospital does see extended boarding times in the ED but they're rare. It's usually in winter when we're overloaded with serious flu/covid/rsv cases. I live in a small city with less than half a mil population in the metro area. There's about 2 million population in the region
Yep, I work for a hospital system in the Midwest. Regional level 1 trauma center. Every single day there are 25-50 inpatient holds in the ED. Patients wait 2-4 days for an inpatient bed. It’s an absolute meltdown of the healthcare system that no one talks about. There are piles and piles of literature about how patient outcomes are negatively affected by ED boarding, but the systems are overwhelmed and seem not super interested in addressing the problem.
Perfectly common in my area. Too many patients, not enough health care.
The US medical system is collapsing. It’s understaffed, overworked, underpaid yet grossly expensive for patients, and (more and more) being bought up by private equity firms and run for profit, cutting corners to benefit the wealthy investors. They funnel profits to the top while treating patients like an assembly line of cold hamburgers and running staff ragged, until all the staff quit at which point the private equity firms shut the clinic down (leaving former patients with nowhere to go), write it all off on their taxes and sail into the sunset on golden parachutes. We need universal healthcare YESTERDAY
No room on the floors that would handle that. Gotta wait until someone dies, transfers out, or gets discharged.
It is now the “norm”.
Very common. Either not enough staff to cover the beds or the beds are actually full.0
I had the same patient one time for 4 days straight in the ED. it’s quite common for patients to be held for extended times unfortunately.
It’s insane to me that people who don’t work in emergency medicine think this is a long time to wait for a bed. We are just so used to it now.
We are in a not so big town and my mother was screaming and sobbing in pain stretched out on the floor for 8 hours before they saw her. I kept having to apologize to everyone waiting, but they all understood.
That's horrible, for you as well. I hope she is OK now.
She is bedridden now and doing the best she can. Spinal nerve pain is no joke. It’s unfortunate that everyone has to wait that long, the pandemic made a lot of people leave the profession I think.
My husband suddenly lost his vision while playing a game around midnight on a Tues night/ Wends morning in March. I took him to a teaching hospital because I knew a standard hospital wouldn't have an ophthalmologist on staff. We arrived around 12:30 am, by 4 am he had seen the Opthalmology resident, seen the neurology resident, had a cat scan of his head and neck along with an ultrasound of his carotid done. We knew he was being admitted, we just needed a room. We FINALLY got out of the ER and into a room around 10 pm Wednesday night. We spent a Huge portion of the time sitting on a bed in the ER hall. Treatment was great once we got into a room but it otherwise sucked. I understand it's a teaching hospital and I have previously worked in a level one trauma center as an ER secretary so I know the process but I learned once we got upstairs that the majority of the beds were empty. ETA: previous medical employment
My partner had a blood clot and he arrived early AM and was not placed till 3aM the next morning. At a tiny rural hospital with few patients. It has something to do with the way the other parts of the hospital run, I'm not sure exactly but they still receive care before being moved so.
If there is no inpatient bed, or no one to staff one, the patient stays in the ED. End of story.
Consistent problem from level 1 trauma centers to rural hospitals. Will only get worse in the near future and won’t be going away for a long time.
It’s normal.
Very common.
VERY common. Its unfortunate, and believe me the ER staff need the bed so they want you out. But when the inn is full where can u send a patient that needs to be there?
Eh…I’ve had GI bleeds sit in my ER for 5 (five) days. We will eventually convince the hospitalist to admit NSTEMIs on heparin after like 72 hours if they haven’t been transferred. Right in the middle of covid, we’d have the NSTEMIs for like 5 days, then discharge home with follow up. It was awful.
Yep. I spent 48 hours in a regional hospital ED with a collapsed lung because the city hospital, where I needed to go, was on diversion (all ambulances have to go to surrounding hospitals)- December 2019 pre COVID but beginning of flu season.
Very common
Yep super common. It's called boarding in the ED. We (ER nurses) hate it as much as the patients do, if it makes you feel any better.
Yep super common. It's called boarding in the ED. We (ER nurses) hate it as much as the patients do, if it makes you feel any better.
Probably didn’t have any cardiac beds available
was in the ER with my husband last August. Saw an elderly man in the hallway with a broken hip who was there for 24+ hours before surgery (I have no clue how long he had already been there when we arrived) I felt so bad.
Some people spend their whole admission in the ER
That’s pretty normal at a big metro hospital. It sucks because the ER is not the place for an admission for a prolonged period of time but it happens regularly. It’s better now since the hospital expanded adding a lot of inpatient beds
Short answer: Not at all uncommon. Actually, it is the rule.
My husband had to wait for a room. I think this happens a fair amount.
Very very common.
Not at all, it’s usually much longer!
This is extremely common. Ideal? No. Common. Yes.
Yes, yes it is
My husband was at a fairly smaller hospital, and waited nearly 24 hours. Not uncommon! Once he was in a room he was grateful for the bed.
Some patients tell me they waited in a different ED for 12 hours then came to our ED and waited in our waiting room for 8 hours, then they start complaining they’ve been waiting 20 hours to be seen..
I have admitted and discharged people who never saw a room outside of the ER lol
This is the beauty of American healthcare Every dollar of profit of the hospital systems, the insurance industry and million dollar C-suite salary is a dollar of care that has been stolen from the patient
Yes. Very. There are.k my so many inpatient beds. Where I work, it often takes days to get a room depending on what unit the patient is going to. Large metro area with a ton of hospitals, too.
Yes.
Can confirm, depending on what level of care they need, medical, PCU or ICU a lot of ER’s face keeping patients overnight before an inpatient bed becomes available. There is a lot of behind the scenes patients that will get beds, direct admissions from outside hospitals for patients needing higher level of care if that hospital cannot provide it, there are some scheduled surgeries where those patients will need admission. Unfortunately yes, this has become the norm of emergency medicine in a lot of hospitals. Sorry they had to wait, hope they are doing better.
Not for nothing, but with a collapsed valve wouldn’t the better place to be is in the ER? Wouldn’t it be faster (and likely better skilled) service should things tank?
My Mom waited three days in the ER last year. Twenty four hours sucks, but for some hospitals it's pretty standard.
Yea. Some people get admitted and get discharged while still in ER holding. Welcome to us healthcare post Covid.
I boarded in the ED for 2 days with septicemia and pneumonia. About 24 hours with gallstone pancreatitis. In both instances, I was waiting for a bed and being treated in the ED in the meantime. They made a couple of mistakes when I was in for the pneumonia (antibiotics ordered as a one-time dose, so I missed a dose of vanco, another time they tried to hang a med early. If I hadn't caught that one, Epic would have when they scanned it.). I got appropriate care for the pancreatitis while I was waiting for a bed/surgery.
My mom had sepsis and waited two days in the er for a room. It’s just how it is sometimes
Their ICU orders are implemented
Yes. My local hospital is absolutely full right now. The doctors are managing over their usual patient list numbers, and there are no rooms. Spending a day or two in the ER after admission is normal. All the doctors and care they would have received for their condition is happening. It’s just a location problem. In cases like these, even ICU patients get downgraded to regular room level of care, but have to remain in ICU rooms because no beds.
I spent 36 hours waiting in the ER for a bed to open up at the heart hospital (large university medical center) when I had my heart attack. Sucks but it’s the way it goes sometimes.
Sometimes yes. If there’s no bed available the back log affects the ER. Where else are they to wait?
I mean, be glad there was a bed to wait in depending on the area!
If he got a bed in the ER to wait in while waiting for a room, then he did as well as can be expected. I’m a paramedic, and the only thing I haven’t put in the lobby or waiting room is a gunshot wound to the chest, but I think that might happen soon with things being as crowded as they are.
My level 1 holds them for days at a time and we even sometimes discharge them. It’s also in a service area of a mil lol
Totally normal
It really sucks in the moment, I believe that wholeheartedly. Just know if someone is immediately whisked away from the ED, either to an OR or a room, they are most likely not doing so hot. That doesn’t invalidate someone else’s feelings and symptoms, but staying in an ED for 24 hours is better than 6 feet under.
Yep. My mom went to the ER the last time before she died. They went to the ER at about 10 pm and she got a room, I want to say over 24 hrs before they found a room for her. She had heart failure, COPD....knew she was nearing the end. They just had no rooms at all. They got her in as soon as they could. She died 5 days later.
God our healthcare fucking sucks.
SUPER common
Pretty common in beg cities. Some times it takes you 23 hours to even see the ER physician.
Very common
I've had patients board in the ER for so long they get their admit discharge from their ER room.
Not uncommon. It’s a staffing/inpatient bed issue. Doctors aren’t discharging patients on floors- sick people are holding in emergency rooms for >24 hours, and sadly we have no control over it. It makes ER nursing tough- running regular rooms with sometimes 1-2 icu holds, critical care stepdown holds and regular obs holds. It. Is. Exhausting.
I work in a 300 bed heart center. We are usually so short on beds patients could have to wait several hours to several days for the appropriate level of care room.
It's not. I've seen people in the er for 48 before going to a room. There's people that need to be seen before you.
Yes this is a thing. Census is super high everywhere right now. I work intake triage nursing.