Doctors Highlight Emergency Department Boarding Crisis During Health System Discussion

Los Angeles City Health Commission convened on August 11, 2025, to address the pressing issue of emergency department (ED) boarding, a critical symptom of systemic dysfunction in healthcare. The meeting highlighted alarming statistics, including a peak of 30 COVID-related deaths daily and over 100 patients intubated in the ICU, underscoring the urgent need for reform.

Emergency department boarding occurs when patients are admitted but remain in the ED due to a lack of available hospital beds. This situation not only compromises patient care but also increases mortality rates, with studies indicating a 5% higher risk of death for boarded patients compared to those presenting with acute conditions like heart attacks. The discussion drew parallels to an airport operating at overcapacity, where planes are left circling without a place to land, illustrating the chaos and danger inherent in the current system.

Dr. Hashim, a key speaker, shared a personal account of his father's experience in the ED, where he waited 18 hours for surgery after being admitted. This anecdote served to humanize the statistics, revealing the real-life implications of ED overcrowding. The meeting emphasized that such delays can lead to dire consequences, including preventable deaths.

The commission explored potential solutions to alleviate the boarding crisis. Suggestions included "hallway boarding," where admitted patients are temporarily placed in hospital hallways to free up ED space, and "surgical smoothing," which involves scheduling surgeries more evenly throughout the week to prevent bottlenecks. These strategies have shown promise in other health systems, leading to reduced boarding times and improved patient outcomes.

Innovative approaches like "hospital at home" were also discussed, allowing patients to recover in their own homes rather than in crowded EDs. This model has been shown to enhance recovery and reduce hospital costs. Additionally, the meeting highlighted the need for a fundamental redesign of healthcare financing to address the root causes of ED boarding.

The commission concluded with a call for increased executive involvement in emergency care management, emphasizing the importance of data-driven decision-making to improve patient flow and outcomes. As Los Angeles grapples with these challenges, the discussions at the Health Commission meeting signal a critical step toward reforming the healthcare system to better serve its community.