Boston – Almost four years after the start of the COVID-19 pandemic, Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham health care system, continues to struggle daily with unprecedented overcrowding – particularly in its Emergency Department (ED). For the past 16 months, the MGH ED has operated nearly every day in “Code Help” or “Capacity Disaster” status, which represents critical levels of ED crowding.
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.
“While hospital overcrowding has significantly affected patient care for many years, COVID-19 and the post-pandemic demand for care has escalated this challenge into a full-blown crisis – for patients seeking necessary emergency care, as well as for staff who are required to work under these increasingly stressful conditions,” said David F.M. Brown, MD, the current President of MGH and former Department Chair of Emergency Medicine at MGH. “This crisis is most acutely felt in our ED, where patients wait hours for an inpatient bed. Put simply, every day between 50 and 80 patients spend the first night of their hospitalization in the ED, which is not an appropriate or therapeutic environment for anyone and contributes significantly to clinician burnout and frustration.”
While many hospitals across the Commonwealth of Massachusetts face capacity constraints, MGH is uniquely challenged amongst its peers because it serves as both an internationally renowned academic medical center that accepts some of the most medically complex patients in the state 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, 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.
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 Philip 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.
- 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.
- Home Hospital Service: 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.
- Patient Transfer and Access Center: In 2023, with the goal of delivering a seamless patient experience across the system, Mass General 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.
MGH has launched a new website for patients to learn more about how the hospital is handling this capacity crisis, with new information posted regularly.
“We will always provide care to every person who crosses our threshold – a responsibility we take extremely seriously,” said Brown. “We have improved inpatient throughput and efficiency and developed innovative care models across our health system and yet we still face overwhelming and increasing ED crowding with no end in sight. That is why adding more beds to MGH will greatly help alleviate this capacity crisis, enhance access for patients and substantially improve the overall working conditions for our clinicians and staff.”
About Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. Massachusetts General Hospital is a founding member of the Mass General Brigham healthcare system.