Emergency Department care teams ask for trust and patience to deal with capacity concerns

An opinion piece by Jennifer V. Pope, MD

Dartmouth Health Vice Chair of Operations, Department of Emergency Medicine, Medical Director, Emergency Department, Dartmouth Hitchcock Medical Center and Alice Peck Day Memorial Hospital, Assistant Professor of Emergency Medicine, Dartmouth’s Geisel School of Medicine

When it comes to healthcare, nobody likes to wait. By definition, emergencies are serious, often dangerous situations requiring immediate action. For those of us caring for patients on the front lines of emergency departments, the escalating patient overcrowding crisis is an enormous challenge and frustrating issue—and for patients, it’s a hard pill to swallow.

However, the first step toward change is awareness. As someone who is dedicated to the delivery of high-quality, safe and efficient emergency medicine at Dartmouth Health’s Dartmouth Hitchcock Medical Center (DHMC) and Alice Peck Day Memorial Hospital, it’s important to be transparent with our patients while we work to resolve this mounting public health crisis.

Even before the pandemic, long waits and patient overcrowding nationwide in emergency departments were a growing problem and now, post-pandemic, this escalating crisis is resulting in an all-too-common healthcare phenomenon known as boarding. “Boarding” is an industry term used to describe an unplanned delay in moving patients from the emergency department to the appropriate care setting because there is simply no available bed for them. New Hampshire is not immune to this public health dilemma. In 2023, DHMC’s annual emergency department volume was the highest in history, and already, 2024 is pacing to top that. And, because DHMC is the largest hospital in New Hampshire, and the only academic medical center and Level 1 trauma center, we are caring for an unprecedented volume of patients with very complex medical needs.

It is important to us that our patients and families know that we do not dismiss these emergency department waits as a mere inconvenience. We know how stressful waiting can be for patients and families. With emergency departments facing unprecedented capacity challenges, patient care must be triaged at equally unprecedented levels. Our nursing partners are working incredibly hard to care for patients with emergent needs like strokes and heart attacks while also caring for patients with inpatient nursing needs. This puts a strain on every aspect of the delivery of emergency care. And, this is not the way that we want to deliver care.

Although it’s a complex issue, at its most basic level, this universal healthcare dysfunction results from a lack of beds. Like so many other states, here in New Hampshire, we simply don’t have enough options to move existing patients out of the hospital beds they occupy and into skilled nursing or other long-term care facilities because those facilities are dealing with the same workforce challenges as we are. The lack of appropriate discharge options translates to emergency department backlogs where it’s not uncommon to find admitted patients waiting on stretchers in hallways for a room to open up. Sadly, the problem disproportionately impacts the elderly, those struggling with mental illness, and other at-risk populations. Often, these individuals do not have access to primary care, or even basic transportation. And, because emergency departments are open 24x7 and are required by law to treat and/or stabilize anyone, these populations often depend on emergency departments as their only source of medical intervention, and ambulance transports as their only transportation option. Sadly, they may have no family or friends to advocate for them or help them to navigate complex decisions.

I went into the field of emergency medicine because I am dedicated to providing high-quality and efficient care to anyone in need. Almost 20 years into my career, that passion has not faded. Our emergency teams are not only experts in their fields but also members of your communities. We are your neighbors. We care deeply about you and your health needs. We are working harder than ever to triage and treat everyone who walks or rolls through our doors. During the pandemic you trusted us with your lives and your loved ones. We ask you to trust us again now as we navigate these unprecedented capacity challenges. By making you aware of this complicated, nuanced issue, we hope a mutual understanding will foster continued confidence in our unyielding commitment to all patients.  And we ask for your understanding and patience. Those in the healthcare system are working to resolve these capacity issues. We are determined.