ER boarding of seniors awaiting hospital care causes preventable hurt
Each day, the scene performs out in hospitals throughout America: Older women and men lie on gurneys in emergency room corridors moaning or struggling silently as harried medical workers attend to crises.
Even when physicians decide these sufferers must be admitted to the hospital, they typically wait within the ER for hours – typically greater than a day – in ache and discomfort, not getting sufficient meals or water, not shifting round, not being helped to the lavatory and never getting the care medical doctors deem mandatory.
ER hallways are “lined from finish to finish with sufferers on stretchers in varied states of misery calling out for assist, together with quite a lot of older sufferers,” stated Hashem Zikry, an emergency medication doctor at UCLA Well being.
Physicians who workers emergency rooms say this downside, referred to as ER boarding, is as unhealthy because it’s ever been – even worse than in the course of the first years of the COVID-19 pandemic, when hospitals full of desperately sick sufferers.
Whereas boarding can occur to all ER sufferers, adults 65 and older, who account for practically 20% of ER visits, are particularly weak throughout lengthy waits for care. Additionally, seniors could encounter boarding extra typically than different sufferers. Estimates printed in 2019 counsel that 10% of sufferers had been boarded in ERs earlier than receiving hospital care. About 30% to 50% of those sufferers had been older adults.
“It’s a public well being disaster,” stated Aisha Terry, an affiliate professor of emergency medication at George Washington College and the president of the board of the American Faculty of Emergency Physicians, which sponsored a summit on boarding in September.
Employees shortages, excessive demand, monetary priorities
Virtually a dozen medical doctors and researchers described the chaotic state of affairs in ERs. They stated workers shortages are contributing to the disaster. Additionally, they stated, directors are setting apart extra beds for sufferers present process profitable procedures, contributing to ER bottlenecks.
Then there’s excessive demand for hospital providers, fueled partly by the growing older of the U.S. inhabitants, and backlogs in discharging sufferers due to rising issues securing house well being and nursing house care, in line with Arjun Venkatesh, chair of emergency medication on the Yale Faculty of Medication.
The influence of lengthy ER waits on seniors who’re frail, with a number of medical points, is particularly critical. Confined to stretchers, gurneys and even laborious chairs, typically with out reliable assist from nurses, they’re vulnerable to shedding power, forgoing important medicines and experiencing issues corresponding to delirium, in line with Saket Saxena, co-director of the geriatric emergency division on the Cleveland Clinic.
When these sufferers lastly safe a hospital mattress, their stays are longer and medical issues extra frequent. And new analysis finds that the chance of dying within the hospital is considerably larger for older adults once they keep in ERs in a single day, as is the chance of antagonistic occasions corresponding to falls, infections, bleeding, coronary heart assaults, strokes and bedsores.
A number of weeks in the past, Zikry helped look after a 70-year-old girl who fell and broke her hip whereas attending a basketball sport. “She was in a nook of our ER for about 16 hours in an immense quantity of ache,” he stated.
Nobody is aware of precisely how frequent ER boarding is and the place is it most acute, as a result of hospitals aren’t required to report that information. The Facilities for Medicare & Medicaid Companies retired a boarding measure in 2021. New nationwide measures of emergency care capability have been proposed however not but permitted.
Within the meantime, some hospital methods are publicizing their plight by highlighting capability constraints and the necessity for extra beds. Amongst them is Massachusetts Normal Hospital, which introduced in January that ER boarding had risen 32% from October 2022 to September 2023. On the finish of that interval, sufferers admitted to the hospital spent a median of 14 hours within the ER and 26% spent greater than 24 hours.
Maura Kennedy, Mass Normal’s chief of geriatric emergency medication, described an octogenarian girl with a respiratory an infection who languished within the ER for greater than 24 hours after physicians determined she wanted inpatient care.
“She wasn’t mobilized, she had nothing to cognitively interact her, she hadn’t eaten and she or he grew to become more and more agitated, making an attempt to get off the stretcher and arguing with workers,” Kennedy stated. “After a chronic hospital keep, she left the hospital extra disabled than she was when she got here in.”
The right way to keep more healthy when ready
When requested what older adults might do about these issues, ER medical doctors pointed to the necessity for bigger system and coverage modifications. Nonetheless, they’d a number of recommendations.
“Have one other individual there with you to advocate,” stated Jesse Pines, chief of scientific innovation at US Acute Care Options. That individual ought to communicate up in the event that they really feel you’re getting worse or if staffers are lacking issues.
Alexander Janke, a scientific teacher of emergency medication on the College of Michigan, advises individuals to be ready to attend at an ER and to carry a medicine record and their medicines.
To remain oriented and cut back the opportunity of delirium, “be sure you have your listening to aids and eyeglasses,” stated Michael Malone, medical director of senior providers for Advocate Aurora Well being in Wisconsin and Illinois. “Each time potential, attempt to rise up and transfer round.”
Mates or household caregivers who accompany older adults to the ER ought to ask to be at their bedside when potential. “Strive to ensure they eat, drink, get to the lavatory and take routine medicines for underlying medical situations,” Malone stated.
Older adults or caregivers ought to attempt to carry “issues that might interact you cognitively: magazines, books … music, something that you just may give attention to in a hallway,” Kennedy stated.
“Skilled sufferers typically present up with eye masks and ear plugs” to assist them relaxation in ERs with nonstop stimulation, stated Zikry of UCLA. Lastly, “carry one thing to eat and drink in case you’ll be able to’t get to the cafeteria or it’s some time earlier than staffers carry these to you.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF – an unbiased supply of well being coverage analysis, polling and journalism.
