Introduction:Emergency departments (EDs) are a vital part of the US healthcare system, yet they are increasingly overwhelmed by the practice of boarding, which involves holding admitted patients in the ED after the decision for hospital admission has been made. Despite extensive evidence, the issue has only worsened. Evidence-based policymaking requires analysis of contemporary studies differentiating boarding from broader crowding consequences. Methods:Leveraging US-based literature from 2014 to 2024, this review synthesizes the health and safety effects of boarding on patients and staff. Twenty-one studies were included: 17 on patient outcomes and 4 on staff impacts. Results:Prolonged boarding times were associated with severe consequences, including worsened mortality, morbidity, length of stay, medication errors, and treatment delays. High-risk populations (eg, pediatric, psychiatric, and older) suffered greater harm. For clinical staff, boarding added workload, hindered resident education, and worsened burnout. Conclusion:This review extends previous studies' findings and supports the proposition that boarding (distinguished from crowding more generally) is not only an operational inconvenience but also a systemic safety hazard with implications for healthcare and policy leaders as they prioritize strategies to improve patient safety. The largest opportunity for further research is in rigorous, prospective, multi-center studies with standardized definitions and outcome measures.
This Viewpoint discusses the One Big Beautiful Bill Act and making Medicaid and the health insurance exchanges sustainable.
BACKGROUND:Lung cancer screening (LCS) with low-dose CT (LDCT) reduces lung cancer mortality, but false-positive tests remain a concern. Radiologist variability in interpreting LDCT scans may contribute to higher false-positive rates (FPRs). METHODS:Radiologists were identified from the LCS registry maintained by the ACR. Registry data were merged with Medicare files to create an LCS registry-Medicare database. Radiologists with ≥50 baseline or ≥50 postbaseline LDCT screens in the database were included in the analysis. The sensitivity and FPR were defined as the proportion of positive (Lung CT Screening Reporting and Data System 3-4) screens among those with and without a lung cancer diagnosis, respectively. Distributions, including median and interquartile range, of radiologists' FPRs were evaluated based on observed data and mixed-effects models, in which the radiologist was the random effect. Sensitivity was computed on an aggregate level based on radiologists' FPR quartiles. RESULTS:In all, 1,130 radiologists read ≥50 baseline screens, and 935 read ≥50 postbaseline screens. Median (interquartile range) FPR for baseline screens was 15.9% (11.3%-21.8%) and 16.3% (11.8%-21.8%) based on observed data and the mixed-effects model, respectively. Corresponding values for postbaseline screens were 8.5% (5.7%-12.8%) and 8.8% (6.3%-11.8%). Sensitivity increased significantly with radiologist FPR quartile for baseline and postbaseline screens. For baseline screens, radiologists in the lower two FPR quartiles had aggregate FPR and sensitivity of 10.9% and 89.6%, respectively, versus 24.1% and 94.4% for radiologists in the upper two quartiles. CONCLUSIONS:Variability in radiologists' FPRs with LDCT screening was high. Higher FPRs were associated with increased sensitivity rates.
This Perspective examines a new Centers for Medicare & Medicaid Services (CMS) approach to outcome-aligned Medicare payments for technology-enabled long-term care.
Cybersecurity hazards pose a myriad of threats to the emergency department function. In this chapter we focus specifically on emergency departments in the U.S. acknowledging there is variation in this function worldwide. With high technological integration, historically poor cyber defense, and potentially catastrophic consequences of disruption - healthcare systems are particularly vulnerable to cyberattack. While discussions of cyberattacks on healthcare systems often focuses on privacy breaches involving the disclosure of personally identifiable information (PII) and protected health information (PHI) which can be resolved with civil litigation, instead we focus exclusively on the disruptive impacts of cyberattacks on hospital emergency departments which extend more importantly to patient continuity-of-care and patient mortality. This chapter is an updated summary with feedback from a paper originally presented at the ACM CCS Cybersecurity in Healthcare (HealthSec) Workshop held in Salt Lake City Utah USA October 2024 [47]. We outline the broad range of potential impacts that cyberattacks have on the delivery of emergency medicine. We discuss downstream consequences of clinical care challenges, infrastructure vulnerabilities, and system-wide ramifications of impaired hospital IT infrastructure as well as potential solutions. We leverage the available literature from a clinical and emergency management lens to highlight the potential consequences of cyberattacks and offer alternative approaches to mitigate and respond to cyberattack disruptions.
