UCLA physicians tell Los Angeles City Health Commission ED boarding raises mortality, harms training

Two UCLA emergency physicians told the Los Angeles City Health Commission that prolonged boarding of admitted patients in emergency departments is causing measurable harm to patients and undermining the training of future physicians.

At a commission meeting, Hashim Zicree, assistant professor of emergency medicine at UCLA, said ED boarding ‘‘is emblematic of health-system dysfunction’’ and cited research linking boarding to worse outcomes. ‘‘There’s a 5 percent increased mortality for patients who board in the emergency department,’’ Zicree said.

A second UCLA physician (an emergency physician and longtime medical communicator who said he had trained at USC and UCLA) described a common scenario in which admitted patients occupy ED beds because inpatient units lack available staffed beds. ‘‘Imagine if LAX closed three and a half of its four runways and parked planes on the runways that are closed,’’ the presenter said. ‘‘That’s the way to describe what’s happening every day in emergency departments across the country.’’

Why it matters: the presenters told commissioners that boarding affects three groups simultaneously — the patients sitting in ED hallways while awaiting inpatient beds, the new patients who cannot get timely evaluation because ED capacity is filled, and trainees who learn to practice ‘‘shallow’’ medicine under time and space pressure. Zicree and his colleague gave examples and cited both local pilots and national policy…