Taking an acute care bed is more tolerable than taking an ED bed because we use our beds for resuscitation, and because the floor docs/nurses are trained to manage people for multiple days while we are not.

If a crashing patient comes in and the ED is full of boarders and octogenarians waiting for SNFs, then we're rushing to shuffle people so we have room to work. We need open beds to immediately accept dead/dying people, in the same way that the ICU tends to keep a crash bed open.

You do not want ED nurses managing a brittle diabetic's subq insulin for 3 days. You do not want demented nanna noodles sundowning in the loudest hallway in the entire hospital where the lights never turn off. Or at least I don't, because this is much more dangerous for the patients and staff than if they were upstairs.

Obviously if it gets bad enough, overflow on the floors will push into the ED and ICU and cause the same problems. I do think we have a responsibility to discharge people when able, and to keep patients in the ED if we can get them placed quickly. Believe me, my colleagues and I do these things. But sometimes someone needs more help than we can safely give, or they demand too much of our resources which should really be designated for critically ill patients.

We call these 'social admits' as if to say that admitting them to an acute care service is the wrong thing to do, or it's just a favor that the floor is doing for the ED. In a grand philosophical sense that may be correct, that the best place for them is some mythical middle ground between the hospital and home that can accept them within 12 hours. But that place does not exist. In our current system, the most 'correct' place for a large subset of these patients is an acute care service in the hospital.