Hospital Boarding Creates Critical Shortcomings in Disaster Preparedness

Hospital patient boarding in emergency departments has reached unprecedented crisis levels over the past 4 years. Boarding and crowding has been demonstrated by prior literature to have adverse effects on patient care as well as increased associated costs. Importantly, the increase in hospital patient boarding has created critical shortcomings in disaster preparedness by limiting the capacity of emergency departments to respond to mass casualty incidents due to space and staffing constraints. Multiple concurrent threats exacerbate these challenges, including increases in the incidence of both natural and unnatural disasters over the past decade and decreases in the numbers of US hospitals, hospital beds, and employed healthcare staff. “Emergency department boarding” must also be renamed “hospital boarding” given that the fundamental challenge lies with hospital and health system leadership and does not stem from emergency departments. In this commentary, the authors share a call to action to increase support and funding for research to alleviate the demands of hospital boarding, greater recognition among hospital leadership of the threat that hospital boarding poses to disaster scenarios, and widespread development of hospital-based, regional plans for mass casualty incident response that are more effective in the context of excessive boarding.