Boarding of Critically Ill Patients in the Emergency Department

Mohr, Nicholas M.; Wessman, Brian; Bassin, Benjamin S.; Elie‐Turenne, Marie‐Carmelle; Ellender, Timothy J.; Emlet, Lillian L.; Ginsberg, Zachary; Gunnerson, Kyle J.; Jones, Kevin M.; Kram, Bridgette; Marcolini, Evie G.; Rudy, Susanna

doi:10.1097/ccm.0000000000004385

Cited by 90 publications

(78 citation statements)

References 56 publications

(53 reference statements)

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“…111,[154][155][156][157][158][159][160] Hypothesized reasons for worse outcomes include delayed administration of subsequent doses of antibiotics, limited monitoring resulting in delayed recognition of changes in patient status, high patient-tonurse ratios, and provider focus on new patient evaluation. 157,161 To optimize outcomes, we advise prioritizing septic shock patients for early inpatient bed availability owing to increased resource and time demands in care management. Furthermore, hospitals should develop systems to provide the necessary care for patients with sepsis who remain in an ED while awaiting an inpatient bed.…”

Section: Subsequent Doses Of Antibiotics Key Pointsmentioning

confidence: 99%

“…Furthermore, hospitals should develop systems to provide the necessary care for patients with sepsis who remain in an ED while awaiting an inpatient bed. 161 During periods of boarding, some facilities incorporate procedures whereby inpatient physician or nurse teams assume care of admitted patients in the ED. These procedures should be clearly delineated so that all members of the care team understand who is responsible and accountable for care.…”

Section: Subsequent Doses Of Antibiotics Key Pointsmentioning

confidence: 99%

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Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report

Yealy¹,

Mohr²,

Shapiro³

et al. 2021

Annals of Emergency Medicine

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Section: Subsequent Doses Of Antibiotics Key Pointsmentioning

confidence: 99%

Section: Subsequent Doses Of Antibiotics Key Pointsmentioning

confidence: 99%

Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report

Yealy¹,

Mohr²,

Shapiro³

et al. 2021

Annals of Emergency Medicine

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“…[8][9][10] Many causes of prolonged ED LOS-such as boarding of patients admitted from the ED due to inpatient bed unavailability-require hospital-wide countermeasures to address. [11][12][13] However, there also is interest in mitigating ED crowding by accelerating patient flow within the ED itself. Provider in triage (PIT)-which typically involves a physician or advanced practice provider conducting an initial screening examination and potentially initiating diagnostic testing and treatment at triage-has been proposed as one ED-controllable mechanism to reduce ED LOS.…”

Section: Introductionmentioning

confidence: 99%

Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact

Franklin

Somand

et al. 2021

JACEP Open

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Emergency department (ED) crowding is recognized as a critical threat to patient safety, while sub‐optimal ED patient flow also contributes to reduced patient satisfaction and efficiency of care. Provider in triage (PIT) programs—which typically involve, at a minimum, a physician or advanced practice provider conducting an initial screening exam and potentially initiating treatment and diagnostic testing at the time of triage—are frequently endorsed as a mechanism to reduce ED length of stay (LOS) and therefore mitigate crowding, improve patient satisfaction, and improve ED operational and financial performance. However, the peer‐reviewed evidence regarding the impact of PIT programs on measures including ED LOS, wait times, and costs (as variously defined) is mixed. Mechanistically, PIT programs exert their effects by initiating diagnostic work‐ups earlier and, sometimes, by equipping triage providers to directly disposition patients. However, depending on local contextual factors—including the co‐existence of other front‐end interventions and delays in ED throughput not addressed by PIT—we demonstrate how these features may or may not ultimately translate into reduced ED LOS in different settings. Consequently, site‐specific analysis of the root causes of excessive ED LOS, along with mechanistic assessment of potential countermeasures, is essential for appropriate deployment and successful design of PIT programs at individual EDs. Additional motivations for implementing PIT programs may include their potential to enhance patient safety, patient satisfaction, and team dynamics. In this conceptual article, we address a gap in the literature by demonstrating the mechanisms underlying PIT program results and providing a framework for ED decision‐makers to assess the local rationale for, operational feasibility of, and financial impact of PIT programs.

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“…The implementation of these initiatives has clear utility as the annual volume of patients needing ICU beds increases without a concomitant growth of traditional ICU geography and immediately available intensivists. 2 As the population lives longer with more chronic diseases, patients will require more complex critical care in the ED.…”

Section: Resuscitation Fellowships Can Close the Gapmentioning

confidence: 99%