Annals Study Details Cost of Boarding

A study in the October issue of Annals of Emergency Medicine is the first of its kind to detail the daily costs of boarding for a hospital.

“Our analysis found that caring for patients who are boarding in the emergency department nearly doubled the daily cost of care for the hospital,” said lead study author Maureen M. Canellas, MD, MBA, FACEP, assistant professor of emergency medicine at the University of Massachusetts T.H. Chan School of Medicine, and associate chief medical officer at the University of Massachusetts Medical Center. “Boarding is a systemic problem that requires collaborative solutions. This cost data should give hospital leaders a new perspective when addressing the boarding crisis.”

The total daily cost per patient was $1,856 for those boarding, which is nearly double the $993 for those receiving inpatient care. The daily cost of boarding intensive care patients in the emergency department was $2,267 compared with $2,165 for those being treated in the intensive care unit. The authors examined the cost of care for 25 patients who had a stroke and then boarded in the emergency department for a combined 563 hours at a large, urban, academic comprehensive stroke center hospital. The study used time-driven activity-based costing to quantify the care cycle by calculating daily resource use, salary data, and operating costs. This research was supported by the Emergency Medicine Foundation and Emergency Medicine Policy Institute’s Health Policy Research Scholar Award.

Boarding is more costly than inpatient care and the overall costs of boarding are likely higher than reported, the authors noted. The study did not factor in other costs associated with prolonged hospital stays, including occupied beds unavailable for evaluation and treatment of new patients, staff inefficiencies, or the potential for malpractice lawsuits.

Although this analysis focused on hospital costs, the dangers for patients are well established. Nearly 70 studies have shown that boarding was associated with elevated health and safety risks, prolonged delays in treatment, and increased likelihood of death. These dangerous bottlenecks are also associated with ambulance diversion, preventable medical errors, violent episodes, and care team burnout.

ACEP Continues to Lead the Call for Accountability, Solutions to the Boarding Crisis

ACEP met with the Biden Administration in late October to discuss its proposal to require hospitals to have plans in place for when they reach capacity. ACEP President Alison J. Haddock, MD, FACEP, urged the White House Office of Management and Budget to adopt an ACEP-developed standard that would require hospitals to create and implement protocol to move admitted patients out of the emergency department when the hospital reaches a specific capacity threshold. ACEP’s comprehensive multiyear efforts to address the root causes of boarding include alerting the White House, sounding the alarm through hundreds of troubling stories directly from the frontlines, and tying boarding-related attestations to hospital performance measures, among other initiatives.