Hospital "boarding" hard on the elderly: study

By Megan Rauscher

NEW YORK (Reuters Health) - Elderly patients who are "boarded" for more than 6 hours in an emergency department waiting for an inpatient bed risk losing their independence and ability to live at home when discharged.

In a study released Monday, researchers found that long waits in the emergency department increase the odds by four-fold that an elderly patient will be discharged from the hospital to a nursing home and not to their own home.

"When there aren't enough open beds in a hospital, admitted patients may be 'boarded' in the emergency department sometimes for hours -- sometimes for days -- until a bed opens up," Dr. Sandra Schneider, of University of Rochester School of Medicine, New York noted in an interview with Reuters Health.

"This really is the primary reason behind emergency department overcrowding," Schneider, one of the study authors, added.

Schneider and colleagues studied 277 elderly patients who visited an emergency department in Rochester, New York, between August 1 and August 31, 2007.

"If they were able to get out of the emergency department within 6 hours, only about 4 percent needed to go to a nursing home," she said. "If they stayed in the emergency department more than 6 hours, 18 percent had to be discharged to nursing homes."

The researchers chose to evaluate a 6-hour period. Australia and Great Britain have already passed legislation that says patients cannot spend more than 6 hours in the emergency department, Schneider explained.

Ten percent of the 277 patients studied were held in the emergency department for more than 48 hours.

"These were 'well elderly' who came in who then could not go home. It's not a good idea to board anybody in the emergency department but we think the elderly probably fare worse," Schneider noted.

Schneider presented the findings Monday at the International Conference on Emergency Medicine in San Francisco.

Schneider thinks elderly patients who are boarded for extended periods of time in the emergency department may experience a decline in function; their muscles becoming "deconditioned." They are also likely to become confused or disoriented due to changes in their environment, noise, light, multiple caregivers and interrupted sleep.

Previous research has shown that boarding of inpatients in the emergency department is associated with increased mortality, increased health care costs and increased time spent in the hospital once admitted.

"Boarding is an urgent national problem for emergency patients of all ages," Dr. Linda Lawrence, president of the American College of Emergency Physicians said in a written statement. "We need to solve the boarding crisis in our emergency departments now."