ED Boarding Would Worsen if Ratio Ballot Question Passed

The Boston Globe had a strong article last week by reporter Liz Kowalczyk highlighting the ongoing problem of emergency department “boarding” for Massachusetts children needing behavioral health treatment.

The article resonated with MHA members that have expressed concern that the nurse staffing ratio ballot questions scheduled for the November ballot would worsen the intractable boarding issue.

“With many families already facing significant hurdles to access mental healthcare for their children, the rigid, government-mandated nurse staffing ratios required under Question 1 will only further constrict the Massachusetts behavioral healthcare system,” said Coalition to Protect Patient Safety spokesperson, Dan Cence. “Increased wait times in the ER and mental healthcare facilities, and decreased access to qualified nurses and mental healthcare professionals will leave our most vulnerable residents even further away from the care they need.”

If behavioral health facilities are unable to recruit the additional RNs required to meet the ratio mandate, behavioral health facilities will be forced to eliminate inpatient behavioral health beds and outpatient services, negatively affecting access to behavioral health throughout the commonwealth.

ED boarding occurs when a patient must wait in an ED until an appropriate inpatient psychiatric or substance use disorder bed is available. The amplified impact of the behavioral health crisis on children is especially evident in the context of ED boarding. Teenagers make up 21% of all behavioral health visits that board. For patients that board for two or more days, children and teenagers make up 59% of all cases.

According to the state Department of Mental Health, the biggest barrier to pediatric behavioral health admissions was a lack of available beds, but existing difficulties in recruiting RNs and other professionals with psychiatric experience also cause significant access obstacles for children and adolescents with behavioral health needs.

Question 1 on the Massachusetts ballot this November would impose strict, rigid, one-size-fits-all nurse staffing ratios at all times on every unit of every hospital in the state. Community hospitals and academic medical centers would need to have the same RN staffing, regardless of the very different patient populations they may care for, or individual nurses’ experience or skills. These ratios would be required at all times – nights, scheduled and unscheduled nursing breaks, patient transfers, and any other time that nurses may need to step away from patients, even for just a few minutes. The law would also impose heavy fines of up to $25,000 per violation, per day, for any infractions.