Hospital overcrowding is a problem for patients, staff, and the hospital’s bottom line. It can lead to delays in getting treatment, poorer health outcomes for the patients, and higher costs for the system. Overcrowding occurs when the need for care exceeds the capacity of a hospital’s emergency department (ED) and its inpatient beds. This causes a range of problems for hospitals including increased waiting times, ambulance diversion, length of stay in the ED and hospital, and medical errors.
The underlying cause of these problems is a lack of bed availability across the hospital. The hospital needs more beds in the ED, the inpatient units, and the ICUs. In addition, the hospital needs to be able to smoothly transition between shifts so that the right number of staff is on duty to handle the workload and ensure patient safety.
Many factors contribute to overcrowding in the ED and throughout the hospital: poor and uninsured patients who don’t get primary care, unnecessary visits due to a lack of standard procedures, safety net issues, surgical scheduling, and seasonal illnesses. However, one of the most important factors is boarding, because it dissipates resources and reduces efficiency.
Boarding is when admitted patients stay in the ED longer than they should because they are awaiting an available inpatient bed or transfer to a hospital ward. Those resources cannot be reallocated to new patients because of the long wait time for a bed. Moreover, the boarding process slows down discharge planning and increases the likelihood of post-discharge complications.