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Medical News & Perspectives
December 17, 2008

Economics May Play Role in Crowding, Boarding in Emergency Departments

JAMA. 2008;300(23):2714-2715. doi:10.1001/jama.2008.753

Chicago—While the closing of hundreds of US emergency departments and the on-call physician shortage for backup services are two reasons offered to explain overcrowding and boarding of patients awaiting inpatient beds in emergency departments, another factor—that some hospitals might be considering boarding as part of a management and financial strategy—may be overlooked.

According to researchers discussing the issue during a session on emergency department crowding at the American College of Emergency Physicians (ACEP) Scientific Assembly held here in October, the current system of offering hospital beds on a first-come, first-served basis favors patients undergoing elective procedures that are scheduled sometimes days or weeks in advance. These patients also are more profitable to a hospital than patients admitted through the emergency department.