This fall, ACEP will participate in the Agency for Healthcare Research and Quality (AHRQ) Director’s summit on emergency department boarding.

ACEP’s participation in such a pivotal meeting was not just luck or convenience. ACEP helped make the summit possible by mobilizing Congress to request action from the Department of Health and Human Services (HHS) during the Leadership and Advocacy Conference in 2023. At that time, emergency physicians helped secure 44 signatories on a congressional “Dear Colleague” letter to the Administration, sounding the alarm onto the boarding crisis and asking them to establish such a task force. And they listened.

ACEP has been using our wide-ranging influence like this for years to work tirelessly with any stakeholder who has a role in boarding solutions to protect you and your patients. As the boarding crisis has escalated in the past few years, a variety of public and often less-than-public efforts have been made by ACEP leaders to solve the problems you face every day in the ED. These meetings, conversations, emails, and exchanges that are constantly happening with federal and state decision-makers to improve the specialty.

Collaborating with Other Stakeholders

Recently, ACEP’s Emergency Medicine Section Council to the American Medical Association (AMA) introduced a resolution, “Improvements to Patient Flow in the U.S. Healthcare System,” for consideration at the AMA House of Delegates 2024 Annual Meeting, June 8 – 12 in Chicago.

This resolution, if passed by the House of Delegates, directs the AMA to work with relevant stakeholders and propose recommendations to appropriate entities to improve patient flow and access to care throughout multiple environments in the U.S. health care system.

In September 2023, ACEP organized and hosted the first National Stakeholder Summit on Boarding to analyze the causes of boarding, discuss barriers to overcoming these causes, and identify priority areas to pursue in creating system-wide solutions.

ACEP prioritized attendance of hospital groups at this boarding summit so they could hear firsthand the impact that boarding is having on patients, physicians, and other health care workers, and also answer to this growing crisis. Certain possible solutions could have unintended consequences, and it’s important that all stakeholders talk through the challenges.

More nurses in inpatient units, for example, can help alleviate ED boarding; however, experience has shown that mandated ratios, especially with current nursing shortages, could exacerbate the problem: if there are too many patients and not enough nurses for the inpatient unit, patients are left boarding in the ED so the inpatient area stays in legal compliance.

That is why the American Hospital Association (AHA) and America’s Essential Hospital, two of the largest organizations representing hospitals, were invited to and urged to attend ACEP’s Boarding Summit. Representatives from both groups attended.

In all, 15 health care organizations participated in the Summit:

• American College of Emergency Physicians
• Agency for Healthcare Research and Quality (AHRQ)
• American Hospital Association
• American Nurses Association
• American Psychiatric Association
• America’s Essential Hospitals
• Apprise Health Insights
• Administration for Strategic Preparedness and Response (ASPR)/Biomedical Advanced Research and Development Authority (BARDA)
• Association of State and Territorial Health Officials
• Emergency Nurses Association
• International Association of Fire Chiefs
• LeadingAge
• National Association of Emergency Medical Technicians
• National Alliance on Mental Illness
• National Governors’ Association

ACEP President Aisha Terry, MD, MPH, FACEP, as well as ACEP’s DC staff, are regularly having one-to-one conversations with hospital executives, government agencies, and others who can effect meaningful change. ACEP will continue pushing these groups to work harder to solve boarding issues, to improve patient safety, and to protect emergency physicians.

Backing State-Level Efforts

ACEP is currently working to provide our Connecticut chapter with a State Public Policy Grant to bolster its efforts to support state legislation that would require hospitals to collect and report data on emergency department wait times and volumes (CT SB 181).

The bill would require annual data on bed capacity, the number of ED patients admitted to the hospital, and average length of time from arrival to admission, among other information. The data would then be posted on the state department of public health’s website.

If passed, the Connecticut proposal would secure the nation’s first reported metrics on boarding at the state level.

Working with the Federal Government

Advocacy strategies work best when they tackle an issue from multiple angles. ACEP has been pushing the federal government – those with actual authority to regulate hospitals – to use its significant power to identify and enact boarding solutions.

We have requested that the recommendation from The Joint Commission (TJC) that no ED patient board for longer than four hours, be changed into a requirement.

ACEP has also asked the TJC and the Quality Improvement Organizations (QIO) program to include ED staffing levels in their assessments because they regulate hospitals and can have significant influence on hospital practices.

There are several requests ACEP has made of the Centers for Medicare & Medicaid Services (CMS), including:

• Call for a new CMS Condition of Participation requiring hospitals to develop contingency plans when inpatient occupancy exceeds 85 percent (or similar threshold), including a load balancing plan and a utilization plan of alternative space and staffing for inpatients when ED licensed bed capacity is occupied.
• Request to modify the CMS measure, “Median Time from ED Arrival to ED Departure for Discharged ED Patients,” to create a bright line standard (e.g., four hours) with a percentage performance (i.e., measure and report the percentage of ED visits that exceeded a certain time frame, rather than just the current median time in minutes that allows everyone to fail together and not reduce the ranking).
• Urge CMS, instead of sunsetting the measure in 2024, to maintain the “Admit Decision Time to ED Departure Time for Admitted Patients” measure in the Hospital Inpatient Quality Reporting Program—one of the only measures available to track this statistic and provide incentives/enforcement to help reduce wait times and boarding.

ACEP has been standing up for the interest of emergency physicians and your patients for decades and we will continue to do so.

Ms. Calaway is ACEP’s Managing Director for Content and Communications Integration.