Price for waiting: the adverse outcomes of boarding critically ill elderly medical patients in the emergency department

Huang, Kuang-Wen; Yin, Chun-Hao; Chang, Renin; Chen, Jin-Shuen; Chen, Yao-Shen

doi:10.1093/postmj/qgae006

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…The lack of a standardized definition and the heterogeneity among studies can compromise the optimal assessment of the impact on patient-centered outcomes and on the healthcare team, leading to conflicting results. Several recent studies have already shown the association with prolonged boarding and worse outcomes [35,36 && ,37 && ,38]. One observational study in more than 5 million patients admitted to all major EDs in England showed that boarding was independently associated with higher 30-day mortality [36 && ].…”

Section: Andandmentioning

confidence: 99%

Boarding in the emergency department: challenges and mitigation strategies

da Silva Ramos,

Freitas,

Machado

2024

Current Opinion in Critical Care

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Purpose of review Herein, we conducted a review of the literature to better understand the issue of prolonged emergency department (ED) boarding by providing an overview of the current evidence on the available causes, consequences, and mitigation strategies. Recent findings Severely ill patients awaiting transfer to intensive care units (ICU) imposes additional burdens on the emergency care team from both a clinical and management perspective. The reasons for prolonged ED boarding are multifactorial. ED boarding compromises patients’ safety and outcomes, and is associated with increased team burnout and dissatisfaction. Mitigation strategies include the optimization of patients’ flow, the establishment of resuscitative care units, deployment of mobile critical care teams, and improvements in training. Staffing adjustments, changes in hospital operations, and quality improvement initiatives are required to improve this situation, while active bed management and implementation of capacity command centers may also help. Summary Considering the characteristics of healthcare systems, such as funding mechanisms, organizational structures, delivery models, access and quality of care, the challenge of ED boarding of critically ill patients requires a nuanced and adaptable approach. Solutions are complex but must involve the entirety of the hospital system, emergency department, staff adjustment, and education.

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Section: Andandmentioning

confidence: 99%

Boarding in the emergency department: challenges and mitigation strategies

da Silva Ramos,

Freitas,

Machado

2024

Current Opinion in Critical Care

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Ist der Schockraum noch zeitgemäß?

Dünser,

Noitz,

Eisenburger

et al. 2024

Anästhesie Nachr

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ZusammenfassungKritisch kranke Notfallpatient:innen stellen unterschiedliche Anforderungen an Art und Dauer der Erstversorgung in einer Notfallabteilung. Während jene mit Trauma häufig so schnell wie möglich einer operativen Versorgung zugeführt werden müssen, unterscheiden sich kritisch kranke Patient:innen mit den unterschiedlichsten nicht-traumatologischen Pathologien sowohl in den Anforderungen an die Dringlichkeit der diagnostischen und therapeutischen Versorgung als auch in der Aufenthaltsdauer bis zur möglichen Reversierung der kritischen Erkrankung oder Festlegung Patient:innen-zentrierter Therapieziele.Die Autoren plädieren dafür, in den Notfallabteilungen intensivmedizinische Behandlungsbereiche zu etablieren, die eine optimale Versorgung aller kritisch kranken Notfallpatient:innen (mit oder ohne Trauma) gestatten und die Anpassung der Behandlungsstrategien an die individuellen Bedürfnisse der Patient:innen erlauben. Schockräume bzw. Schockraumbehandlungsplätze zur Versorgung von Notfallpatient:innen, die einer Zeit-fokussierten und multiprofessionellen Erstbehandlung bedürfen (z. B. Schwerverletzte, Patient:innen unter laufender oder Z. n. kardiopulmonaler Reanimation, Patient:innen unter extrakorporaler kardiopulmonaler Reanimation (eCPR)) sollen in diesen Intensivbehandlungsbereichen integriert sein.

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Price for waiting: the adverse outcomes of boarding critically ill elderly medical patients in the emergency department

Cited by 2 publications

References 27 publications

Boarding in the emergency department: challenges and mitigation strategies

Boarding in the emergency department: challenges and mitigation strategies

Ist der Schockraum noch zeitgemäß?

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