'Full-Blown Crisis:' Mass General Out Of Hospital Beds

BOSTON, MA — Massachusetts General Hospital is experiencing a "full-blown crisis" with its capacity, operating nearly every day in "Code Help" or "Capacity Disaster" status in its emergency department for 16 months straight, hospital officials said Friday.

As patient volume grows, the emergency department's status can change from "Normal Operations" to "Pre-Code Help" to "Code Help" and finally to "Capacity Disaster," according to officials.

"Code Help" occurs when inpatient beds and monitored hallway stretchers are full, and "Capacity Disaster" is triggered when the emergency department is full, all hallway stretchers are being used, and there are more than 45 inpatients boarding in the emergency department awaiting a hospital bed.

For the 12 months spanning October 2022 to September 2023, patients boarded — or were held in the emergency room while they awaited a room for admission — for a total of 381,228 hours, a 32 percent increase from the previous 12-month period, officials said. These patients are often waiting in stretchers and chairs in hallways or in other temporary spaces.

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On Jan. 11, 103 patients boarded in the emergency department, "marking one of the most crowded days MGH has experienced in its two centuries caring for Boston and its surrounding communities," according to officials.

"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," David F.M. Brown, MD, the current president of Massachusetts General Hospital and the hospital's former department chair of emergency medicine, said.

Brown continued: "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."

Officials noted that while many hospitals across the state and the country face capacity constraints, Massachusetts General Hospital is "uniquely challenged" because of its internationally renowned academic medical center that accepts some of the most medically complex patients in the state, and the fact that it also serves as the community hospital for Chelsea, Charlestown, Everett, Revere and large parts of Boston.

In addition to capacity problems in the hospitals, health officials attribute crowding to workforce shortages and seasonal upticks in viral infections.

To help combat crowding issues, the Massachusetts Department of Public Health issued a memo on Jan. 9, urging expedited discharge planning as soon as it is safe for patients to be released from hospitals.

Other steps the hospital is taking to ease overcrowding are increasing the number of inpatient beds, using a discharge lounge for patients about to be released, and offering home hospital services, officials said.

"We will always provide care to every person who crosses our threshold – a responsibility we take extremely seriously," Brown said. "We have improved inpatient throughput and efficiency and developed innovative care models across our health system and yet we still face overwhelming and increasing emergency department 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."