For emergency physicians, boarding and crowding isn’t a new problem. But in the past several months, you’ve made it clear things have worsened. Multiple factors converged, building a groundswell with the potential to drown emergency departments (ED) across the country. This longtime problem was now escalating rapidly. ACEP staffers heard the sense of urgency in your voices: You were once again on the front lines, only this time the front line felt more like teetering on a tightrope, dangerously close to a tipping point.

The past 20 years of advocacy efforts on boarding have shown ACEP’s advocacy team that all the data in the world hasn’t moved the needle on the issue. Boarding and crowding in the ED has been a problem that is too broad, too multifactorial, too overwhelming for policymakers to address.

Your voices have gotten ACEP leadership to think, “as the collective voice for emergency physicians, how could we raise the red flag on this issue in a way that would get legislators to hear and feel your new desperation surrounding this old problem?”

It was time to let your own stories do the talking.

Story Collection

In late October, ACEP put out a call asking for members to anonymously submit their “most severe and egregious boarding stories.” The submissions immediately poured in, quickly tallying more than 100 in the first week. Your testimonials painted a grim picture of the heartbreaking reality for many EDs across the country.

As ACEP’s advocacy team read through all the submissions, certain themes emerged:

• Boarding is causing patients to experience preventable harm—even death.
• Many patients, even those who need to be admitted, are being treated in the waiting room without ever reaching a bed in the ED.
• Pediatric patients and patients with mental health emergencies are disproportionately affected.
• When physicians and other members of the care team feel they can’t provide quality care, professional burnout increases.
• Staffing shortages, especially within nursing, are making the boarding problem worse.
• Economic realities incentivize hospitals to prioritize staffing and space for more lucrative surgery patients over other admissions.

Imploring the White House

ACEP constructed a letter to the White House that outlined the severity of the situation in your own words. In the nine-page letter, ACEP called on the White House to host a summit to gather all relevant stakeholders in one place to start seeking collaborative solutions.

Prior to sending, ACEP circulated the letter among its diverse and influential network to get an additional 34 organizations to sign on, adding even more weight behind the message.