Effect of a Boarding Restriction Protocol on Emergency Department Crowding

Abstract

Purpose Access block due to the lack of hospital beds causes crowding of emergency departments (ED). We initiated the “boarding restriction protocol” that limits the time of stay in the ED for patients awaiting hospitalization to 24 hours from arrival. The purpose of this study was to determine the effect of the boarding restriction protocol on ED crowding. Materials and Methods The primary outcome was ED occupancy rate, which was calculated as the ratio of the number of occupying patients to the total number of ED beds. Time factors, such as length of stay (LOS), treatment time, and boarding time, were investigated. Results The mean of the ED occupancy rate decreased from 1.532±0.432 prior to implementation of the protocol to 1.273±0.353 after ( p <0.001). According to time series analysis, the absolute effect caused by the protocol was -0.189 (-0.277 to -0.110) ( p =0.001). The proportion of patients with LOS exceeding 24 hours decreased from 7.6% to 4.0% ( p <0.001). Among admitted patients, ED LOS decreased from 770.7 (421.4–1587.1) minutes to 630.2 (398.0–1156.8) minutes ( p <0.001); treatment time increased from 319.6 (198.5–482.8) minutes to 344.7 (213.4–519.5) minutes ( p <0.001); and boarding time decreased from 298.9 (109.5–1149.0) minutes to 204.1 (98.7–545.7) minutes ( p <0.001). In pre-protocol period, boarding patients accumulated in the ED during the weekdays and resolved on Friday, but this pattern was alleviated in post-period. Conclusion The boarding restriction protocol was effective in alleviating ED crowding by reducing the accumulation of boarding patients in the ED during the weekdays.

Emergency department crowding: an overview of reviews describing measures causes, and harms

“…Throughput is defined as the flow of patients through the ED, which includes triage, time to diagnostic testing, and treatment [ 4 ]. Discharge of patients and movement to inpatient units represents the output component and represents a commonly cited reason for crowding in emergency departments [ 4 , 6 – 9 ]. Output reflects challenges within healthcare systems as whole.…”

“…Output reflects challenges within healthcare systems as whole. This is especially emphasized considering when boarding of admitted inpatients within emergency departments is decreased, crowding and wait times are significantly reduced [ 4 , 9 ].…”

Reducing the length of stay for patients stranded in the emergency department: A single-center prospective study of 18,631 patients in China

“…Public Grade III general hospital experiences a high volume of patients throughout the year. As a result, there are certain challenges, such as limited bed availability in the wards, high bed utilization in the emergency rooms, [23] and a high turnover rate among medical staff. [24] 2.2.3.5.…”