Long ER waits plague understaffed hospitals, affecting the elderly | CNN

KFF Health News

Every day, the scene plays out in America’s hospitals: elderly men and women stretch out on stretchers in emergency room corridors moaning or suffering in silence while stunned medical staff attend to crises.

Even when doctors determine these patients need to be admitted to the hospital, they often wait hours, sometimes more than a day in the ER in pain and discomfort, without enough food or water, unable to move, not getting help to go to the bathroom, and not getting the kind of care that doctors think is necessary.

You walk down the ER corridors and they are lined end to end with patients on stretchers in various states of distress begging for help, including several elderly patients, said Hashem Zikry, an emergency physician at UCLA Health.

Doctors who work in emergency rooms say this problem, known as emergency boarding, is as bad as it has been even worse than during the early years of the Covid-19 pandemic, when hospitals they were filled with desperate patients.

Although boarding can happen to all ER patients, adults age 65 and older, who account for nearly 20% of ER visits, are particularly vulnerable during long waits for care. In addition, elderly people may encounter boarding more often than other patients. The best estimates I could find, published in 2019, before the Covid-19 pandemic, suggest that 10% of patients were admitted to emergency rooms before receiving hospital care. Between 30% and 50% of these patients were older adults.

It’s a public health crisis, said Aisha Terry, associate professor of emergency medicine at George Washington University School of Medicine and Health Sciences and chair of the board of the American College of Emergency Physicians, which sponsored a summit on boarding in September.

What is happening? I spoke with nearly a dozen doctors and researchers who described the chaotic situation in emergency rooms. I was told that the shortage of staff in hospitals, which affects the number of beds available, is contributing to the crisis. In addition, they explained, hospital administrators are reserving more beds for patients undergoing lucrative surgeries and other procedures, contributing to bottlenecks in emergency rooms and leaving more patients in limbo.

Then there is high demand for hospital services, fueled in part by an aging U.S. population, and delays in patient discharges due to growing problems securing home health care and care in nursing homes, according to Arjun Venkatesh, chair of emergency medicine at Yale. Faculty of Medicine.

The impact of long ER waits on elderly people who are frail, with multiple medical problems, is particularly severe. Confined to stretchers, stretchers or even hard chairs, often without reliable help from nurses, they risk losing strength, forgoing essential medications and experiencing complications such as delirium, according to Saket Saxena, co-director of the geriatric emergency department at the Cleveland Clinic. .

When these patients finally get a hospital bed, their stays are longer and medical complications more common. And new research finds that the risk of dying in hospital is significantly higher for older adults when they stay in emergency rooms overnight, as well as the risk of adverse events such as falls, infections, bleeding, heart attacks, strokes and ulcers.

Ellen Danto-Nocton, a Milwaukee geriatrician, was deeply concerned when an 88-year-old relative with stroke-like symptoms spent two days in the ER a few years ago. Delirious, motionless and unable to sleep as the alarms outside his bed rang incessantly, the older man spiraled downward before being taken to a hospital room. He really needed to be in a less chaotic environment, Danto-Nocton said.

Several weeks ago, UCLA Health’s Zikry helped care for a 70-year-old woman who had fallen and broken her hip while attending a basketball game. He was in a corner of our emergency room for about 16 hours in an immense amount of pain that was very difficult to treat properly, he said. ERs are designed to manage crises and stabilize patients, not to care for patients we’ve already decided need to be admitted to the hospital, he said.

How common is emergency boarding and where is it most serious? No one knows, because hospitals are not required to publicly report boarding data. The Centers for Medicare and Medicaid Services withdrew a boarding measure in 2021. New national emergency care capacity measures have been proposed but not yet approved.

It’s not just the scope of ED onboarding that we need to understand. It’s the extent of acute hospital capacity in our communities, said Yale’s Venkatesh, who helped draft the new measures.

Meanwhile, some hospital systems publicize their plight, highlighting capacity constraints and the need for more hospital beds. Among them is Boston’s Massachusetts General Hospital, which announced in January that emergency boarding had increased 32% from October 2022 to September 2023. By the end of that period, the patients admitted to the hospital spent an average of 14 hours in the ER and 26 hours. % spent more than 24 hours.

Maura Kennedy, the hospital’s chief of geriatric emergency medicine, described an 80-year-old woman with a respiratory infection who languished in the ER for more than 24 hours after doctors decided she needed hospital care.

She didn’t mobilize, she had nothing to engage her cognitively, she hadn’t eaten, and she became increasingly agitated, trying to get off the bunk and arguing with the staff, Kennedy told me. After an extended hospital stay, he left the hospital more disabled than when he entered.

When I asked ER doctors what older adults could do about these issues, they told me that boarding is a health care system problem that needs health care system and policy changes. Still, they had several suggestions.

Have someone else there with you to advocate on your behalf, said Jesse Pines, chief clinical innovation officer at US Acute Care Solutions, the nation’s largest physician-owned emergency medicine practice. And get that person to talk if they think you’re getting worse or if the staff isn’t having a problem.

Alexander Janke, a clinical instructor of emergency medicine at the University of Michigan, advises people: Be prepared to wait when you come to an emergency room and bring a medication list and your medications, if you can.

To stay focused and reduce the chance of delirium, make sure you have your hearing aids and glasses with you, said Michael Malone, medical director of senior services at Advocate Aurora Health, a 20-hospital system in Wisconsin and the northern Illinois. Whenever possible, try to get up and move around.

Friends or family caregivers who accompany older adults to the ER should ask to be at the bedside, when possible, and try to make sure they eat, drink, go to the bathroom, and take routine medications for medical conditions underlying, Malone said.

Older adults or caregivers who help them should try to bring things that interest you cognitively: magazines, music books, anything you can focus on in a hallway where there isn’t a TV to entertain you, Kennedy said. .

Experienced patients often show up with eye masks and earplugs to help them rest in ERs with nonstop stimulation, UCLA’s Zikry said. Also, bring something to eat and drink in case you can’t make it to the cafeteria or it will be a while before the staff brings them to you.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF the independent source of health policy research, polling and journalism.

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