• Planning for discharge at time of admission. Making early arrangements for patients who will need outpatient placement in a nursing home or rehabilitation facility can speed their discharge by as much as 22 hours (J. Hosp. Med. 2009;4:226-33).
• Monitoring room-cleaning turnaround times. Cleaning staff should be held accountable for prompt work.
• Simplifying the steps needed to admit patients.
• Performing "reverse triage." During peak times, patients who have the least need for a bed can be discharged.
The most commonly adopted of these nine proven measures are actively managing bed use (quickly available bed information, 66% of hospitals; bed coordinator, 51%) and smoothing surgical schedules (58%).
Taking action to reduce boarding requires "a clear commitment by hospital leadership to overcome operations barriers across departments," Dr. Rabin and her coauthors said.
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A new focus on proven measures is needed if hospitals want to cut down on patient boarding.
"Boarding is a systemwide problem, and successful responses require the endorsement of hospital leaders. ... If continued education of hospital managers and the public does not result in change, enhanced regulation will be necessary to protect patients," they concluded.
All of the authors are members of the Emergency Department Crowding Interest Group of the Society for Academic Emergency Medicine. No disclosures were reported.