Department of Emergency Medicine

(FEBRUARY 8, 2024) In an impassioned opinion piece in VT Digger, four Vermont emergency medicine physicians explain a crisis in our emergency departments known as “boarding”—unplanned delays in moving to the appropriate care setting because there is no available bed—and plead for an increase in skilled nursing and long-term care beds, home health supports, and robust, reliable funding mechanisms to support both.

The Larner-affiliated physicians—Ben Smith, M.D., medical director of the Central Vermont Medical Center Emergency Department; Julie Vieth, M.D., medical director of the University of Vermont Medical Center Emergency Department; Matthew Siket, M.D., emergency physician and medical officer of the University of Vermont Health Network Care Coordination System; and Ryan Sexton, M.D.’09, medical director of the Northeastern Vermont Regional Hospital Emergency Department and immediate past president of the Vermont Medical Society—write that “the single largest contributor to this crisis is a lack of care options for those who require medical rehabilitation, long-term care, or home health. Every hospital in the state is caring for patients who could move to another setting if it were available. When those patients cannot leave, those beds are then unavailable for the acutely ill and injured, who arrive primarily through the ED. Boarding ensues, care is displaced into hallways and the waiting room, people increasingly go unseen after unreasonably long wait times, and emergencies go untreated …

“We desperately need our state and federal leaders to take this issue seriously,” they conclude, “to correct the deep inadequacies of Medicare and Medicaid funding, and to find a way to dramatically increase supports for the elderly and the vulnerable.”