A new report from the Minnesota Department of Health and Wilder Research shows how common “boarding” is statewide. It’s a practice that parents and health care professionals have been raising the alarm about for years.

It’s defined as a patient remaining in the emergency department more than four hours once a decision is made about where they should go next.

“It’s very stressful,” said Nathan Hierlmaier, a senior researcher with MDH. “Showing up at an emergency room is very stressful even if you’re not experiencing a mental health issue or behavioral health issue.”

The data was collected over 14 days at 33 emergency departments and 13 in-patient units last fall. It showed 537 patients, including both youth and adults, experienced emergency department transfer or discharge delays. There were 182 patients who experienced in-patient discharge delays. This represents 18% and 17% of those patients, respectively.

“One of the most impactful findings is the most common reason for discharge delays in this study were associated with a lack of available beds and safe bedding,” said Kristin Dillon, associate director of research for Wilder Research. “Specifically, about 60% of transfer and discharge delays in emergency departments were due to a lack of space in in-patient units and about a third of discharge delays in in-patient units is a lack of beds in residential treatment for mental health, or substance use concerns, or a state psychiatric bed.”

According to the report, additional availability of beds would have resulted in 311 fewer unnecessary days in emergency departments and more than 404 fewer days in in-patient units.

“We’re talking hundreds of patients and hundreds of days that were spent in care that they didn’t need to be in that particular setting,” said Dillon.

Patients covered by Medicaid or Minnesota Care represented most of the patients who experienced an in-patient discharge delay, according to the report. Black patients were also disproportionately affected.

The report calls for policy changes that will improve moving patients to other settings in a timely fashion, streamlining the legal decision-making process, and reducing administrative barriers.

“We need to fix this and we need to find a way forward,” said Hierlmaier. “The key solution is not simply the hospital walls, it’s outside the hospital as well.”