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Am J Emerg Med. 2018 Jul;36(7):1246-1248. doi: 10.1016/j.ajem.2018.03.043. Epub 2018 Mar 20.

Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service.

Author information

1
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States. Electronic address: klord1@uthsc.edu.
2
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States. Electronic address: vivek.parwani@yale.edu.
3
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States. Electronic address: andrew.ulrich@yale.edu.
4
Center for Healthcare Innovation, Redesign and Learning, Yale University, New Haven, CT, United States. Electronic address: e.finn@yale.edu.
5
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States. Electronic address: craig.rothenberg@yale.edu.
6
Center for Healthcare Innovation, Redesign and Learning, Yale University, New Haven, CT, United States; Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States. Electronic address: beth.emerson@yale.edu.
7
Center for Healthcare Innovation, Redesign and Learning, Yale University, New Haven, CT, United States. Electronic address: alana.rosenberg@yale.edu.
8
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States; Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, United States. Electronic address: arjun.venkatesh@yale.edu.

Abstract

OBJECTIVE:

Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality.

METHOD:

We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015. This study was conducted in an urban, academic hospital with an annual adult ED census over 90,000. We defined boarding as patients with greater than 4h from ED bed order to ED departure to hospital ward. The primary outcome was a composite of adverse outcomes in the first 24h of admission, including RRT activation, care escalation to intensive care, or in-hospital mortality.

RESULTS:

A total of 31,426 patient encounters were included of which 3978 (12.7%) boarded in the ED for 4h or more. Adverse outcomes occurred in 1.92% of all encounters. Comparing boarded vs. non-boarded patients, 41 (1.03%) vs. 244 (0.90%) patients experienced a RRT activation, 53 (1.33%) vs. 387 (1.42%) experienced a care escalation, and 1 (0.03%) vs.12 (0.04%) experienced unanticipated in-hospital death, within 24h of ED admission. In unadjusted analysis, there was no difference in the composite outcome between boarding and non-boarding patients (1.91% vs. 1.91%, p=0.994). Regression analysis adjusted for patient demographics, acuity, and comorbidities also showed no association between boarding and the primary outcome. A sensitivity analysis showed an association between ED boarding and the composite outcome inclusive of the entire inpatient hospital stay (5.8% vs. 4.7%, p=0.003).

CONCLUSION:

Within the first 24h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding.

KEYWORDS:

Boarding; Emergency department; Overcrowding

PMID:
29605480
DOI:
10.1016/j.ajem.2018.03.043

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