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The COVID-19 emergency is over. So why are hospital emergency rooms still crowded?


If you've been to an emergency room lately, then you know how long it can take to get care. That's even though pandemic overcrowding has mostly gotten better. ER doctors say they're overstretched with treating patients who may not always need ER care. Dr. Aisha Terry is president-elect of the American College of Emergency Physicians. Her organization recently briefed Congress on the problem. Welcome to the program.

AISHA TERRY: Thank you so much. I appreciate being here.

RASCOE: Let's start with that briefing. What was the warning that you delivered?

TERRY: Well, you know, the message was really clear - first of all, that boarding or patient boarding is a clear and present public health danger affecting thousands of individual and collective patients every single day. In fact, this is really more a symptom of the floundering of the current health care system in general.

RASCOE: And Doctor, when you say boarding, what do you mean by boarding?

TERRY: Boarding is when a patient remains in the emergency department, even after a disposition has been made in terms of what their care should be, sometimes even for days and months and weeks, which I know blows people's minds, and not getting the care that they need, the care that they deserve and the attention.

RASCOE: What are the most common issues people are seeking care for when they come to the ER?

TERRY: One thing that is so important to remember is that the emergency department is the safety net of health care in our country. We see patients presenting with chest pain, abdominal pain, headaches. We certainly see patients even in labor about to deliver a baby. We see lacerations and orthopedic injuries and broken bones. Essentially, we are the jack of all trades, if you will, and we're there 24/7 to care for patients. The problem with boarding is that it's really interfering with the inherent function of the safety net, because when we can't move patients essentially the whole system backs up. We just don't have physical space. So we find ourselves literally going into the waiting rooms to take care of patients from there or taking care of patients in the hallway. But we as emergency physicians are doing the best we can with what is really a systems problem. And that's what I really want to emphasize. This is not because, you know, we're not moving quick enough. I would say that rather than even refer to it as boarding, it should probably be called health system overload.

RASCOE: People may have a lot of difficulties accessing health care. They don't have a regular doctor, so they go into the emergency room. What does that mean for the emergency room?

TERRY: We see patients every day who have really delayed coming in to get care for problems that are then exacerbated. And oftentimes the treatment requires more than just being in the emergency department. It requires that they be admitted to the hospital and stay overnight and get testing and various management and modalities. Part of the problem with health system overload is that it's a health equity problem. Individuals who are marginalized, such as individuals dealing with mental illness, tend to fare worse when it comes to being able to get the care that they need in the health care system and even in the emergency department.

RASCOE: Can you tell us how COVID and doctor shortages might have made this worse?

TERRY: A big piece of it does relate to there being inadequate staffing of nurses, inadequate staffing of technicians, inadequate staffing of transporters and even physicians. The COVID pandemic certainly took a toll on all of us, and we've certainly seen increased attrition in terms of early retirement and the like, and that impacts our ability to take care of patients. If you think about it, if there's a bed available for a patient, but if there is no nurse there to tend to that patient in the bed, then essentially it's like there's no bed.

RASCOE: Yeah. What are the solutions here?

TERRY: First and foremost, increased awareness about the problem. We also engage the Department of Health and Human Services, hoping that they will launch a boarding task force again with various stakeholders. We are working really hard to engage patient advocacy groups as well. We are working really hard to make sure that emergency physicians have resources so they know how to start the conversation about this problem with their emergency department and hospital administrators, as well as with state officials.

RASCOE: That's American College of Emergency Physicians President-elect Dr. Aisha Terry. Doctor, thank you so much for speaking with me.

TERRY: Thank you so much. I really appreciate the opportunity. Transcript provided by NPR, Copyright NPR.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.

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