Boarding

This problem occurs in some – not all hospitals. The reasons are complex – but as this article suggests we could solve the problem. Holdover In the ER.

Jonelle Rowe, 64, of the District, woke up at 3 a.m. with an acute attack of colitis. Rowe, who is a physician, realized she had to go to the hospital and dialed 911. The ambulance team came “in a flash,” she recalls. They gave her oxygen, started an intravenous line and took her to the emergency room.

For 13 hours she was immobile on a gurney with the safety sides up. She was vomiting and in pain. At times, she was lying in her own bloody feces. It took outside physician pull to get her admitted finally to the intensive care unit.

Rowe was what’s known in medical circles as a “boarder” — a patient who waits in the ER for a hospital bed to open up. Boarders are sick enough to need hospital care, but ER staff is usually too overwhelmed to give them much attention. Rowe was given pain medication and a barf basin, but mostly the nurses rushed by. “They don’t have staff,” Rowe says. “They are working as hard as they can. It’s a system problem.”

Boarders spotlight a gap in medical care — and in homeland security that political leaders refuse to see. The hospital is not as visible as a bridge or a nuclear power plant, not as symbolic as the White House or the Statue of Liberty. But emergency rooms form the front line against injury and illness — whether the attack on civilians is caused by bacterial agents or enemy agents.

Rowe’s story is a familiar one to ER physicians. “It’s happening all over the country, and it is driving us crazy,” says Arthur L. Kellermann, chairman of emergency medicine at Emory University. Boarders can be stuck for 12, 18, 24, 36 hours in the ER, he says. “Public officials are in a state of denial. What would we do in a bioterrorism attack?” Or an outbreak of an infectious disease such as SARS?