Emergency department boarding: a descriptive analysis and measurement of impact on outcomes

Salehi, Leila; Phalpher, Prashant; Valani, Rahim; Meaney, Christopher; Amin, Qamar; Ferrari, Kiki; Mercuri, Mathew

doi:10.1017/cem.2018.18

Cited by 41 publications

(37 citation statements)

References 38 publications

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“…Several factors affect LOS in ED patients, including organizational factors (such as shortage of beds leading to hospital transfer, radiological imaging, or sequential specialist consultations), as well as patient and hospital-specific factors (such as patient age, hospital teaching status, hospital size, and delayed ED throughput of trauma patients) [18][19]. Additionally, Salehi et al demonstrated that patients under isolation, under telemetry, older patients, and patients with a greater comorbidity burden had prolonged waits in the ED (either as prolonged ED LOS or prolonged boarding) and these prolonged boarding times were associated with greater inpatient LOS [20]. Importantly, ED boarding contributes to the increased morbidity and mortality of trauma patients by delaying the initiation of trauma ICU (TICU)-specific care protocols, which drive the trauma care outcomes, especially during initial resuscitation efforts [4].…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Boarding of Non-Trauma Patients Adversely Affects Trauma Patient Length of Stay

Hymel¹,

Leskovan²,

Thomas³

et al. 2020

Cureus

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Introduction Emergency Department (ED) boarding delays initiation of time-sensitive protocols for trauma patients and makes them susceptible to increased mortality and morbidity. In this study, we compared the ED boarding times of non-trauma patients and ED length of stay (LOS) of trauma patients. Methods This was a single-center retrospective cohort study in a Level 1 trauma center. The median boarding time among non-trauma patients and ED LOS among trauma patients was determined by month between the period of April 2018 to March 2019. Linear regression and Pearson correlation coefficient were used to express the magnitude and direction of the relationship between these two variables. Results During the study period, the mean number of non-trauma patients admitted in our ED per month was 1,154 and trauma patients was 89. The mean of the median boarding time per month for non-trauma patients was 76 minutes, and the mean of the median ED LOS per month for trauma patients was 198 minutes. There was a significant positive correlation between boarding time for non-trauma patients and ED LOS for trauma patients (Pearson correlation coefficient: 0.73; p = 0.007). Conclusion The long boarding times for non-trauma patients is associated with ED LOS for trauma patients, indicating that the total patient volume in the hospital contributes to the trauma patient's stay in the ED. Thus, ED LOS of trauma patients can be minimized by improving overall ED and hospital flow, including non-trauma patients.

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Section: Discussionmentioning

confidence: 99%

Emergency Department Boarding of Non-Trauma Patients Adversely Affects Trauma Patient Length of Stay

Hymel¹,

Leskovan²,

Thomas³

et al. 2020

Cureus

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“…One explanation for this finding could be an effect of undertriage were patients with medical urgency remain undetected by the triage tool. It is well described that patients with nonspecific symptoms and low clinical urgency often have increased hospitalization, increased ED-LOS, increased mortality and more often are of advanced age and frail [27,[37][38][39][40]. Different triage tools are often validated against proxy outcomes of ED performance such re-admission rate or mortality.…”

Section: Discussionmentioning

confidence: 99%

The association between length of stay in the emergency department and short term mortality

Wessman

Ärnlöv

Carlsson

et al. 2020

Preprint

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Background: The detrimental effects of increased length of stay at the emergency department (ED-LOS) for patient outcome have been sparsely studied in the Swedish setting. Our aim was to further explore the association between ED-LOS and short term mortality in patients admitted to the EDs of two large University hospitals in Sweden. Methods: All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n=639 385) were retrospectively included. Logistic regression analysis was used to determine association between ED-LOS and 7 and 30-day mortality rates. All patients were triaged according to the RETTS-A into different levels of medical urgency and subsequently separated into five quintiles of ED-LOS. Results: We observed that prolonged ED-LOS was associated with increased mortality for patients with lowest triage priority (risk estimates for 30-day mortality were OR 1.49 (CI 95% 1.20-1.85) for patients with triage priority group 4 and the highest quintile of ED-LOS. No such association was observed in patients with the highest triage priority group and in patients admitted to in-hospital care. Conclusion : Our data suggest that increased ED-LOS could be associated with slightly increased short term mortality in patients with lower clinical urgency and dismissed from the ED but that this does not include patients admitted to in-hospital care.

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“…This follows and is perhaps accentuated by prepandemic ED and hospital overcrowding issues. 12 Some districts considered enacting prehospital and inpatient critical care triage protocols determining medical futility adapted from the Maryland framework for the allocation of scarce life-sustaining medical resources in a catastrophic medical emergency. 13 To handle the surge, many systems created inpatient COVID units on other floors and other units in nontraditional spaces (ie, hospital meeting rooms, clinic offices).…”

Section: Operational Challenges In a Pandemic Or Other Time Of Crisismentioning

confidence: 99%

Pandemic Guidance for Stroke Centers Aiding COVID-19 Treatment Teams

Wira

Goyal

Southerland

et al. 2020

Stroke

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The coronavirus disease 2019 (COVID-19) pandemic has in some regions overwhelmed the capacity and staffing needs of healthcare systems, necessitating the provision of resources and staff from different disciplines to aid COVID treatment teams. Stroke centers have multidisciplinary clinical and procedural expertise to support COVID treatment teams. Staff safety and patient safety are essential, as are open lines of communication between stroke center leaders and hospital leadership in a pandemic where policies and procedures can change or evolve rapidly. Support needs to be allocated in a way that allows for the continued operation of a fully capable stroke center, with the ability to adjust if stroke center volume or staff attrition requires.

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Emergency department boarding: a descriptive analysis and measurement of impact on outcomes

Cited by 41 publications

References 38 publications

Emergency Department Boarding of Non-Trauma Patients Adversely Affects Trauma Patient Length of Stay

Emergency Department Boarding of Non-Trauma Patients Adversely Affects Trauma Patient Length of Stay

The association between length of stay in the emergency department and short term mortality

Pandemic Guidance for Stroke Centers Aiding COVID-19 Treatment Teams

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