Mass General Hospital reveals a 32 percent spike in patient boarding at its emergency department, impacting patient access and experience. Over 12 months, patients were boarded for a total of 381,228 hours, leading to critical ED overcrowding. MGH attributes this surge to the lingering effects of the COVID-19 pandemic, pushing its emergency care capabilities to the brink. In response, MGH is actively increasing licensed inpatient beds and improving discharge processes. The hospital also plans to leverage collaborative efforts and innovative care models to mitigate the challenges of ED overcrowding and patient boarding. This crisis necessitates industry-wide exploration of sustainable solutions to ensure timely and quality emergency care.
Massachusetts General Hospital (MGH) faces a critical escalation in inpatient boarding within its emergency department (ED), an issue exacerbated by the aftermath of the COVID-19 pandemic. Patient boarding, resulting in prolonged wait times and safety concerns, has surged by 32 percent between October 2022 and September 2023. This poses significant challenges to patient access and experience. MGH, grappling with heightened emergency department statuses for 16 months, is implementing a multifaceted strategy to address this crisis. The hospital’s response includes expanding inpatient capacity, enhancing the Discharge Lounge, and collaborating with neighboring healthcare providers.
The magnitude of the Problem:
During the aforementioned 12-month period, patients were boarded in the MGH ED for a staggering total of 381,228 hours. The hospital’s emergency department has consistently operated at heightened statuses, such as “Code Help” and “Capacity Disaster,” for the past 16 months. In these critical situations, inpatient beds and monitored stretchers are fully occupied, exacerbating the challenges of providing timely and effective care.
Patient Experience and Safety Concerns:
The repercussions of increased patient boarding extend beyond operational challenges. In September 2023 alone, patients at MGH’s emergency department experienced a median boarding duration of 14.1 hours, with 26 percent of admitted patients enduring more than 24 hours in the ED. This prolonged waiting period not only compromises patient comfort and privacy but also raises serious patient safety concerns. Patients are often left in hallways, on stretchers or chairs, contributing to a suboptimal and potentially unsafe care environment.
Impact of the COVID-19 Pandemic:
MGH attributes the surge in patient boarding to the aftermath of the COVID-19 pandemic, which has stretched the hospital and its peer institutions to their limits. According to MGH President Dr. David F.M. Brown, the pandemic has escalated the long-standing challenge of hospital overcrowding into a full-blown crisis, affecting both patients seeking emergency care and the healthcare staff operating under increasingly stressful conditions.
Hospital Response and Future Plans:
In response to the crisis, MGH is actively addressing the patient boarding issue. The hospital aims to increase its licensed inpatient beds by 94 upon the completion of the Philip and Susan Ragon Building. This expansion is expected to alleviate ED overcrowding by creating additional capacity for inpatient care. Furthermore, MGH plans to enhance the Discharge Lounge, where patients can wait during discharge, thereby freeing up beds earlier for new admissions.
The hospital also seeks to leverage hospital-at-home services, transitions of care, and collaboration with the neighboring Cambridge Health Alliance to address low-acuity ED overflow. By adopting these strategies, MGH aims to ameliorate both overcrowding and patient boarding concerns.
Challenges and Potential Solutions:
While patient boarding is not unique to MGH, the hospital faces the challenge of limited inpatient bed availability. A September 2022 analysis in JAMA Network Open and a March 2022 Health Affairs blog post suggests that patient boarding has become more prevalent post-pandemic, and certain financial incentives may help reduce this practice. However, hospitals like MGH, constrained by bed limitations, must delve into further examination to identify sustainable solutions to the patient boarding problem.
Mass General Hospital’s battle against escalating patient boarding in the emergency department emphasizes the urgency for innovative solutions. The hospital’s commitment to expanding inpatient capacity and improving patient flow is a crucial step in addressing the broader issue of ED overcrowding. With a patient-centric approach, MGH aims to enhance not only access to care but also the overall emergency care experience. As the healthcare industry grapples with the consequences of the pandemic, collaborative efforts, increased capacity, and strategic partnerships become imperative to ensure efficient and high-quality emergency care for patients across the board.
