Massachusetts General Hospital (MGH) is currently struggling daily with unprecedented overcrowding. Although the current capacity challenges impact every corner of the hospital, they are most acutely felt by sick patients waiting in the Emergency Department (ED) for an inpatient bed. For the past 16 months, the MGH ED has operated nearly every day in “Code Help” or “Capacity Disaster” status, representing critical levels of ED crowding.
While many hospitals across the Commonwealth of Massachusetts face capacity constraints, MGH is uniquely challenged because it serves as both an internationally renowned academic medical center that accepts some of the most medically complex patients in New England and simultaneously operates as the community hospital of choice for places like Chelsea, Charlestown, Everett, Revere, and large parts of Boston.
Recognizing this ongoing crisis across the state, the Massachusetts Department of Public Health (DPH) issued an official memo on January 9, 2024, urging expedited discharge planning as soon as it is safe for patients to be released from hospitals, citing significant capacity issues within the Commonwealth’s health care system, workforce shortages, and seasonal upticks in viral infections.
This page provides information on the concept of a capacity challenge in health care, outlines our efforts to address ongoing capacity challenges at MGH, and answers frequently asked questions.
Facts and Figures: MGH’s ED Capacity
This list was updated in January 2024. It will continue to be updated with important information.
- As patient volume grows, the ED’s status can change from “Normal Operations” to “Pre-Code Help” to “Code Help” and finally to “Capacity Disaster.” “Code Help” occurs when inpatient beds and monitored hallway stretchers are full, and “Capacity Disaster” is triggered when the ED is full, all hallway stretchers are being used and there are more than 45 inpatients "boarding" in the ED awaiting a hospital bed.
- A patient “boarding” in the ED is a patient who is sick enough to be admitted to the hospital but must remain in the ED because there are no available hospital beds – and this wait time is in addition to the time the patient spent waiting in the ED to be seen initially to receive treatment.
- For the 12 months spanning October 2022 to September 2023, patients boarded in the MGH ED for a total of 381,228 hours, a 32% increase from the previous 12-month period.
- In September 2023, patients admitted to the hospital boarded for a median of 14.1 hours per patient, and 26% of admitted patients boarded in the ED for more than 24 hours. These patients are often waiting in stretchers or chairs in hallways or in other temporary spaces.
- On January 11, there were 103 patients boarding in the ED, marking one of the most crowded days MGH has experienced in its two centuries caring for Boston and its surrounding communities.
What Is a Hospital "Capacity Challenge"?
A hospital “capacity challenge” refers to a situation where the demand for health care services exceeds the available capacity of the hospital due to limitations in the number of inpatient beds, infrastructure, resources, or staff. For example, the MGH ED regularly treats and admits more patients to the hospital in need of an inpatient bed than there are inpatient beds available. This results in longer ED stays for patients in need of an inpatient bed, placing added pressure on ED resources (i.e., space, staff, etc.) and forcing patients to be cared for in hallways or other temporary spaces rather than in a room. It also leads to challenges in managing patient flow, providing timely care, and maintaining optimal conditions for both patients and staff across other parts of the hospital.
In the event of a medical emergency, patients should still call 9-1-1 or go to their nearest emergency room.
How Is MGH Addressing its Capacity Challenges?
MGH is taking several steps to help address this crisis and reduce capacity constraints at the hospital.
Increase the Number of Inpatient Beds
With the crisis being most acutely felt by sick patients waiting in the ED for an inpatient bed, MGH is seeking to amend its previously approved Determination of Need (DoN) application with DPH to achieve a net increase of 94 licensed inpatient beds on its existing campus once construction of the Phillip and Susan Ragon Building is complete. In 2022, DPH partially approved MGH’s DoN and conditioned future approval of new inpatient beds on providing more data to support the need for such beds. This incremental increase in the hospital’s inpatient footprint will provide tremendous capacity relief by creating an appropriate landing spot for the existing patients that continue to overcrowd the MGH ED on a daily basis. The addition of these beds does not require further construction or capital expenditures.
The Mass General Capacity Coordination Center
The Center works closely with the ED, all inpatient floors and ICUs, and procedural areas to ensure a seamless patient flow. The Center organizes transfers, admissions, and bed placements.
Through the Center, MGH has implemented several key programs to address the capacity issues, including:
- Collaborating with clinicians across the hospital to ensure that patients transferred from other hospitals genuinely need MGH inpatient services, preventing unnecessary transfers.
- Operating programs that reduce the length of stay for patients who were transferred from other hospitals.
- Supporting inpatient units facing barriers to discharge or care progression, including challenges with tests, imaging, procedures, or other necessary services.
Wang Lobby Discharge Lounge
Serving nearly 125 patients per month, the Discharge Lounge allows staff on inpatient floors to facilitate earlier discharges and open beds to other patients sooner. The average patient spends one hour in the Lounge before being picked up – freeing up 60 minutes for a new patient to occupy the bed. For those needing additional support during discharge, the Lounge also provides a Care Van service, which helps patients without reliable transportation get home safely. Since November 2022, the Care Van has transported more than 500 patients.
Neurosciences Receiving Unit
The Neurosciences Receiving Unit (NSRU) receives transfer patients in need of urgent care following a stroke or other serious brain or nervous system condition, even when a bed is not immediately available in the Neuroscience ICU. When a transfer request comes in from an outside hospital, the Mass General Capacity Coordination Center works with a neurointensivist or neurosurgeon to determine whether the patient is a candidate for the NSRU.
Mass General Brigham Home Hospital
Mass General Brigham Home Hospital is one of the largest and most established services of its kind in the country, where eligible patients receive acute-level hospital care from trusted providers in the comfort of their own home. With 24/7 remote vital sign monitoring, multiple visits from clinicians daily, sophisticated telehealth technology, and an integrated team available around the clock, Home Hospital provides the same world-class services patients would receive during a traditional hospital stay.
Mass General Brigham Patient Transfer and Access Center
In 2023, with the goal of delivering a seamless patient experience across the system, Mass Genreal Brigham launched a new Patient Transfer and Access Center that brings together clinical experts and bed placement specialists from both of its academic medical centers to work in coordination. The Center coordinates care for patients being transferred into or within the system, connecting a patient with the right bed across the system’s academic medical centers, specialty hospitals, and community hospitals. This allows the system to move lower acuity patients to more appropriate, less expensive settings across the system.
Clinical Collaboration with the Cambridge Health Alliance (CHA)
MGH urgent and primary care centers proactively offer to send patients in need of emergency care to CHA Everett as an alternative to the congested MGH ED. Additionally, MGH inpatients who live near CHA Everett may opt to complete their hospital stay at CHA Everett when they no longer need a specialized level of care delivered at MGH.
Frequently Asked Questions
We've compiled a list of frequently asked questions below to provide clarity and support for patients, caregivers, and providers navigating emergency health care during capacity challenges. Whether you're seeking information on appointment availability, understanding referral processes, or exploring alternative care options, our goal is to guide you through this process.
Can patients still receive emergency care during a capacity crisis?
Yes, even during a capacity crisis, we remain committed to providing high quality care to every patient who comes through our doors. MGH is an internationally renowned academic medical center that accepts some of the most medically complex patients in the state and simultaneously serves as the community hospital of choice for communities like Chelsea, Everett, Revere, Charlestown, and large parts of Boston. We have established protocols, surge plans, and resource allocation strategies to navigate capacity challenges while prioritizing patient well-being. Our priority is to deliver excellent care to every individual, and we appreciate your understanding and cooperation during these demanding times.
Are there alternative care options during a capacity crisis?
In the event of a medical emergency, patients should still call 9-1-1 or go to the nearest emergency department. If your health concern is not an emergency, you should contact your primary care provider as a first step. They can help you over the phone or recommend urgent care if that’s what you need.
Is telemedicine an option during a capacity crisis?
Your primary care provider is always a good place to start for health conditions that require timely care. Many offices now offer telehealth appointments for urgent issues. In the event of a medical emergency, patients should still call 9-1-1 or go to the nearest emergency department.
If your primary care provider recommends urgent care rather than the ED, Mass General Brigham Virtual Urgent Care offers several convenient ways to access care virtually. These virtual options can save patients a trip to urgent care and both new and current patients can schedule a virtual urgent care visit for that day or the next day on Mass General Brigham Patient Gateway.
What To Do In Case of Emergency
Mass General Brigham providers provide information for what to do in the event of various emergencies. The information in these videos is provided solely for informational and educational purposes and should not be used in place of professional medical advice, diagnosis and treatment from your physician or another qualified health provider that may be available to you.
What To Do If Someone Is Choking
Melisa W. Lai-Becker, MD, emergency medicine physician at Mass General Brigham, discusses how to respond to someone choking, and how to perform the Heimlich maneuver on adults and infants.
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