The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.com under a content-sharing agreement.
As they try to anticipate the loss of billions to the Ohio health care system, emergency doctors warned last month that it would make patient boarding a lot worse. That’s when people have to lie for hours in the emergency department, waiting for a bed to open up in the appropriate department of the hospital.
Such waits are known to increase the likelihood of bad health outcomes and even death.
An analysis published in June found that even before Medicaid cuts kick in, the problem is getting a lot worse. Health Affairs, a peer-reviewed journal, published the analysis.
It found that boarding times reached their peak in January 2022 — which is partly attributable to the coronavirus pandemic. But it also found that they’re still elevated above their pre-pandemic levels.
“… we found that hospital boarding in the ED beyond four hours has become increasingly widespread,” wrote the authors, Laura G. Burke and Adrian Haimovich, both of Beth Israel Deaconess Medical Center in Boston, and Alexander T. Janke of the University of Michigan.
“Boarding in excess of twenty four hours, which was rare before the pandemic, is now more common, particularly among marginalized patient populations.”
This means that sick patients who have been stabilized in the emergency room have to wait in a room or sometimes a hallway for many hours or even a full day or more, just to be admitted to the appropriate place in the hospital — even the intensive care unit — and receive the full care that they need.
Patients in that situation often get sicker and sometimes die when they wouldn’t have otherwise.
A 2020 paper published in Critical Care Medicine said mortality among those sick enough to need intensive care was 37.6% if they were immediately admitted.
Mortality rose to 43.4% if they had to wait in the emergency department between two and 12 hours.
Death rates rose from there, with 57.1% of patients who had to wait more than 24 hours dying at hospital.
The analysis published in Health Affairs said that well under 15% of patients faced boarding times of four hours or more going into the pandemic. That rate had risen to about 25% as of last September, according to the analysis of 46.2 million hospitalizations.
About 1% or less of patients had to wait 24 hours or more at the start of the pandemic in March 2020. That rose to more than 2% last year.
“Boarding is a key indicator of hospital capacity strain; its sustained increase portends dangerous clinical conditions during future pandemics or other disasters,” the authors wrote.
Christina Campana, president of the Ohio Chapter of the American College of Emergency Physicians, said boarding times and the time it takes to be first seen in the emergency department are going to get a lot longer once funding cuts under President Donald Trump’s One Big Beautiful Bill Act begin to bite.
They’re estimated to slash nearly $1 trillion in Medicaid spending, including about $33 billion in Ohio.
Estimates say the bill will create an additional 440,000 uninsured Ohioans. Many of its effects won’t be felt immediately because the law’s most important provisions don’t take effect until January 2027 — two months after the midterm elections.
Campana said hospitals are going to have to figure out how to pay for people when they lose their insurance because they’re not going to stop getting sick.
One way hospitals will cope is by limiting staff in emergency departments and elsewhere in the hospital, Campana said. That would increase how long patients have to wait before being taken to the place where they can get appropriate care.
The analysis published by Health Affairs seems to indicate that’s already happening.
“We’re in a boarding crisis currently,” Campana said in an interview last month. “There are no hospital beds.”
She said there will be even fewer once the One Big Beautiful Bill Act takes full effect.
“Patients don’t get the right care because the emergency department just doesn’t have the capacity and resources to carry out inpatient medicine,” she said. “The patients suffer again because there’s nowhere to put anybody. They don’t get the care that they need.”
