We will also continue to have discussions with the entities who we invited to the boarding summit a few months ago.

It’s one thing to talk amongst ourselves as emergency physicians about the boarding crisis. It’s another thing to talk to the nurses about it. It’s another thing to talk to EMS about it, the hospital administrators about it, the CEOs of hospitals about it, and even patient-advocacy groups about it. And all of those individuals were at the table at our boarding summit.

Dr. Dark: When we look at those groups, there’s one group that particularly needs to be accountable for this. This is the hospitals and the executives of those hospitals. Because when we think about it, a lot of times some people will mistakenly call this emergency-department boarding. It’s not really emergency department boarding, it is inpatient boarding. What can we do as a specialty to hold those individuals in those hospitals accountable for things like short staffing, but also for staff turnover and for boarding itself?

Dr. Terry: You’re absolutely right. I actually prefer to refer to boarding as hospital system overload. It’s a problem that manifests itself in the emergency department, but no doubt about it, it’s a systems problem and the entire hospital system has to take accountability for it. One way that we hold the hospital accountable is to, again, have discussions with the hospitals and with the CEOs, to understand their angle and also so that they can understand why we care so much. Then we must come together to figure out how to align our incentives in a way that moves the needle. I also think that we need to increase the number of emergency physicians who are CEOs of hospitals; our accreditation program seeks to address this issue by creating standards to include boarding and wait times that the hospital would need to adhere to. The accreditation program that we’re rolling out in 2024 will hopefully create the carrot, and some standards that not only apply, certainly to the emergency physician, but to the hospital too.

Dr. Dark: I’m glad to hear that ACEP is pursuing this through its accreditation program. I’m pretty disappointed that CMS got rid of its boarding measure that hospitals had to report on a few years ago, because I think that was one way you could look at one hospital and see who performs better than another. One thing that I do want to touch on: You said hospital system overload, which is an interesting way to phrase it. I feel like that is loosely related to patient dissatisfaction in the hospital, which I feel like blends over into workplace violence. When patients get frustrated, they get tired of being in the ED, they lash out at nurses and eventually lash out at doctors. If there’s anything you wanted to recap about what ACEP’s doing in regard to workplace safety, I would like to hear about that.