Boarding battles: Pharmacist perils in the land of limbo

Emergency departments (EDs) across the country have grappled with overcrowded conditions for decades, which has only intensified in recent years, leading to the current crisis of ED boarding. The magnitude of boarding in the ED today is an unprecedented challenge faced by hospitals across North America and results in ambulance diversions, complications due to delays in care, and unacceptable numbers of individuals leaving without being seen by a provider. Boarding has significant immediate and downstream effects, including delayed care, medication errors, delirium, higher rates of morbidity and in-hospital mortality, and greater healthcare costs. As expected, ED boarding has also led to burnout and dissatisfaction among members of the medical team due to increased workload, patient safety concerns, lack of knowledge, resources, and/or training, and poor communication.

Clinical pharmacists, particularly those specializing in emergency medicine, are well positioned to address the multifaceted challenges of ED boarding. Emergency medicine pharmacists (EMPs) play a pivotal role in mitigating many challenges of ED boarding by providing tangible interventions, including continuous pharmacotherapy monitoring and management, supporting smooth transitions of care, enhancing electronic medical records, and fully leveraging automated dispensing cabinets. This article details how EMPs can optimize these elements of care for boarding patients with commonly available resources.

Despite the adverse impact ED boarding has on patient outcomes and quality of care, solutions remain scarce and long-term fixes likely require large-scale health-system reformation. Until then, we must institute protocols and workflows to improve the care of boarding patients within existing patient care constraints.