We have the same problem. Some have boarded so long they are rounded on by the inpatient teams and discharged from the ED without getting an inpatient bed. We had this problem before COVID, namely due to lack of capacity and a ridiculously sick population. A lot is staffing. It got worse during the drop in visits when COVID kicked off because they laid off Nurses, PA's and closed the ED Obs unit at one of our campuses. Now, they're scrambling to find staff, but after the hospital CEO stepped on his dong on TV saying that the staff was bringing in COVID, not the lack of PPE, it just got harder.
The ED Obs unit just reopened, managing to poach a couple of midlevels from other departments and find a couple of new hires. They're also working on an adult hospitalist service for our Women's and Children's campus to open up those beds and decrease transfers to the other 2 campuses for adult care.
Little to no psych beds keep people in the department for 48+ hours, recent record is 100+ hours before transfer.
We've been trying to send our pending SNF, hospice, easy dispos to our outlying community campus, depends on the mood of the hospitalists there and whatever they are trying to send to the mothership.
My personal best has been to evaluate, order labs and imaging and get a patient admitted to the orthopedic surgical service while they are sitting in a wheelchair under the entrance awning, smoking a cigarette.
