Dingell, Fitzpatrick Lead 42 Members in Urging HHS to Address Patient Boarding

Representatives Debbie Dingell (D-MI) and Brian Fitzpatrick (R-PA) today led 42 of their House colleagues in sending a bipartisan letter to Department of Health and Human Services (HHS) Secretary Xavier Becerra urging the department to convene a task force to address the growing public health crisis of emergency department (ED) patient boarding. Boarding takes place when a patient cannot be sent home from the ED or transferred to another facility for further treatment because there are no available beds, so they must wait, or be “boarded” in the ED – often for hours, sometimes days, or even weeks.

Boarding places a strain on already-stressed emergency departments, and on top of this, EMS crews bringing emergency patients in via ambulance are often left waiting what can be hours to be able to safely hand over their patient to hospital ED staff, keeping them from being able to respond to new calls for help in the community.

“Even with the worst of the COVID-19 pandemic now behind us, hospital emergency departments all over the country are at, or even past, the breaking point, with no relief in sight,” the lawmakers write. “It led to a nurse in Washington calling 911 as her ED became completely overwhelmed with waiting patients and boarders. Her story is not unique—it is happening right now in EDs across the country, every day. To paint a broader picture of the distressing scope of the ED boarding problem, the American College of Emergency Physicians collected hundreds of firsthand accounts from emergency physicians who have shared their stories from the front lines.”

“Boarding affects patients of all kinds, regardless of their condition, age, insurance coverage, income, or geographic location. These excessive waits for needed care directly harm patients through worse outcomes, increased risk of medical errors, and even avoidable deaths. One emergency physician account noted that in addition to average boarding times of more than 70 hours at their hospital, “…we have patients who unfortunately have died in our waiting room while awaiting treatment. These deaths were entirely due to boarding.” Emergency department boarding also disproportionately affects more vulnerable and historically disadvantaged populations,” the lawmakers continue. “One study found that Black patients wait for about one hour longer than non-Black patients before they are transferred to an inpatient bed. Another found that cognitive stressors, specifically overcrowding and patient load, are associated with increased implicit bias that may affect patient care. Those with acute psychiatric conditions, especially children and adolescents, are particularly hard hit by boarding and may board for months at a time.”

“If the system is already this strained, how will emergency departments be able to cope with a sudden surge of patients from a natural disaster, mass casualty event, or another disease outbreak? Our communities rely upon the safety net that our dedicated health care professionals provide, and we cannot accept these conditions as a “new normal”,” the lawmakers conclude. “As another emergency physician stated, “The crisis is bigger than can be managed by a single hospital or even the medical system alone. We need help from policymakers.” Again, we urge you to convene a task force with broad stakeholder representation – including members of other federal agencies – on the emergency department boarding crisis as soon as possible to identify, develop, and implement both immediate and long-term solutions to this public health issue. Such a task force should include physicians, nurses, government representatives, EMS, hospitals, patient groups, and other entities who can help inform solutions to this urgent problem.”

The letter is signed by Representatives Lisa Blunt Rochester, Shri Thanedar, Stephen Lynch, Alma Adams, Lance Gooden, Seth Magaziner, Eleanor Holmes Norton, Annie Kuster, Paul Tonko, Tony Cárdenas, Mariannette Miller-Meeks, Chellie Pingree, Dan Goldman, Don Davis, Marie Gluesenkamp Perez, Raúl Grijalva, Nanette Barragán, John Joyce, Andy Barr, Terri Sewell, Marc Veasey, Jasmine Crockett, Angie Craig, Emanuel Cleaver, II, Kim Schrier, Bill Foster, Larry Bucshon, Ami Bera, Derek Kilmer, Brittany Pettersen, Mike Thompson, Becca Balint, Bill Johnson, Haley Stevens, Adam Schiff, John Sarbanes, Sean Casten, Robin Kelly, Mark DeSaulnier, Neal Dunn, Lizzie Fletcher, and Raul Ruiz.

View the full text of the letter here.