The latest nationwide fad in the marketing of emergency medicine is the “Senior ED.” I’m sure many of you have heard the radio ads or seen the billboards. There’s an older voice spouting the virtues of comfortable beds, highly competent nurses, and a quiet environment. It’s ED nirvana.

I’m surprised it took hospitals this long to figure this out. My place has been a Senior ED for some time now. A quick glance at the board reveals a large selection of people born about the time of the Hoover administration. We managed to attract all sorts of old people without the hype.

We all work in Senior EDs, but this marketing touts that a particular hospital has decided to specifically cater to the crowd born before the invention of FM radio. Patient nurses who can speak loudly, large clocks, nonslip floors, comfortable beds, large flat-screen televisions, and acoustic surfaces are just a few of the innovations.

I think that these improvements are keen and boss (gotta know the slang if you’re going to work in a Senior ED). These enhancements are so fantastic that I believe they would be great for all our patients. Who wants noise? Who wants to slip and fall? Who wants to get a precipitous bedsore from reclining on cardboard masquerading as a mattress? And who would not want a spacious quiet room in which to receive flowers while waiting 20 hours for an inpatient bed?

These things are universally delightful. So I say to you, Mr. Hospital Administrator, we should do these things for all our patients. But before we do, there are a few other issues to address. Why are our patients sentenced to a day of torture in the ED before they can get to an inpatient bed? (I suppose the cramped double room upstairs doesn’t seem so bad after a day with us in the ED.) And why do we have a workspace that was built for half of our current census?

Our administration is working to improve our situation, but we still have some days when bunk beds are needed. I made the suggestion that we might need to add hanging numbers so we can keep better track of hall patients. Doing this would be good for patient safety; however, I believe that the day we hang numbers from the ceiling is the day we admit defeat. We admit that the hospital is so inefficient that patients cannot be discharged in a timely fashion and rooms cannot be cleaned promptly. We admit that the solution is so far off that “temporary” numbers are needed, and we delude ourselves that the administrators will not start counting these spots as real rooms as if there were walls, sinks, suction, and an overhead light.

Let’s get serious about the boarding problem before considering a new marketing plan. Let’s plug the hole in the ship before we start serving hors d’oeuvres. Until there are no patients in the hall and they all get to an inpatient bed within an hour of the order, the rest is just fluff.

The term “hall patient” has such negative connotations now that soon hospitals will come up with some PC euphemism like “unroomed.” Sure, Mr. Hospital Administrator, come help me do a pelvic exam on this unroomed patient. Come help me have a hall conversation about HIV.

Boarding is a colossal problem, but I get the sense that nobody other than emergency physicians and nurses are interested in a solution. It’s certainly not the Joint Commission. I’m sure many of you have experienced the administrator anxiety syndrome that happens before any Joint Commission visit. Nothing gets done except policy fluffing, floor buffing, and boss bluffing. The surveyors stroll through and deem the hospital safe from expired Neosporin and incorrect color-coded disaster policies and then move on to frighten another set of suits. But where is the National Patient Safety Goal for boarding in the ED? It’s great that we can wash our hands 60 times a day now as long as you don’t trip over the eight unroomed patients on your way. What will it take to get hospitals to do the right thing?

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.

Dr. Robert C. Solomon is medical editor of ACEP News.