An analysis of emergency department-boarded patients awaiting inpatient beds

Year 2022, Volume: 3 Issue: 2, 97 - 104, 31.05.2022

Şule Yakar , Levent Avsarogullari

Abstract

Background: Emergency department (ED) overcrowding and boarding are the most important factors that affect health services and quality of care all over the world. The objective of this study is to evaluate the length of stay of patients boarded in the ED and to analyze patients’ data in respect to the length of stay.

Methods: This prospective study was carried out in a one-year period. The study included patients older than 18 years old who stayed in the ED more than 3 hours after the decision to transfer the patient to the relevant department due to unavailability of vacant inpatient beds. The mode of arrival to the ED, demographic features, the length of stay, clinical course, and outcomes were recorded and statistically analyzed.

Results: A total of 1750 patients were included in the study. Thirty-five percent of patients stayed more than 24 hours in the ED. Department of Infectious Diseases admitted the highest number of the patients (22.5%). Patients’ need for Intensive Care Unit, departments awaited to admit patients, and patients’ Emergency Severity Index were compared to patients’ length of stay and Charlson Comorbidity Index. Differences between groups were statistically significant (p<0.05).

Conclusions: Insufficient number of inpatient beds is a major factor contributing to the ED boarding and overcrowding, which may have various unfavorable effects on both patient safety and functionality of EDs. Multidisciplinary solutions are required to overcome the problem.

Keywords

Boarding, Emergency Department, Overcrowding, Prolonged Wait Times

References

• 1. Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernández- Frackelton M, et al. Estimating the Degree of Emergency Department Overcrowding in Academic Medical Centers: Results of the National Emergency Medicine Department Overcrowding Study (NEDOCS). Acad Emerg Med. 2004;11:38-50.
• 2. Richardson DB, Mountain D. Myths versus facts in emegency department overcrowding and hospital access block. Med J Aust. 2009;190:369-74.
• 3. Erenler AK, Akbulut S, Guzel M, Cetinkaya H, Karaca A, Turkoz B, et al. Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital. Turk J Emerg Med. 2016;14:59-63.
• 4. Mahsanlar Y, Parlak I, Yolcu S, Akay S, Demirtas Y, Eryigit V. Factors Affecting the Length of Stay of Patients in Emergency Department Obsevation Units at Teaching and Research Hospitals in Turkey. Turk J Emerg Med. 2016;14:3-8.
• 5. Olshaker JS, Rathlev NK. Emergency department overcrowding and ambulance diversion: The impact and potential solutions of extended boarding of admitted patients in the emergency department. J Emerg Med. 2006;30:351-6.
• 6. Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo CA. A conceptual model of emergency department crowding. Ann Emerg Med. 2003;42:173-80.
• 7. Laam LA, Wary AA, Strony RS, Fitzpatrick MH, Kraus CK. Quantifying the impact of patient boarding on emergency department length of stay: All admitted patients are negatively affected by boarding. J Am Coll Emerg Physicians Open. 2021;2:e12401.
• 8. Veen D, Remeijer C, Fogteloo AJ, Heringhaus J, Groot B. Independent determinants of prolonged emergency department length of stay in a tertiary care centre: a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2018;26:81.
• 9. Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20:402-5.
• 10. Cowan RM, Trezeciak S. Clinical review: Emergency department overcrowding and the potential impact on the critically ill. Crit Care. 2005;9:291-5.
• 11. Farahmand S, Karimialavijeh E, Vahedi HS, Jahanshir A. Emergency medicine as a growing career in Iran: an Internet-based survey. World J Emerg Med. 2016;7:196-202.
• 12. Kilicaslan I, Bozan H, Oktay C, Goksu E. Demographic properties of patients presenting to the emergency department in Turkey. Turk J Emerg Med 2005;55-13.
• 13. Mirhaghi A, Kooshiar H, Esmaeili H, Ebrahimi M. Outcomes for Emergency Severity Index Triage Implementation in the Emergency Department. Journal of Clinical and Diagnostic Research. 2015;9:4-7.
• 14. Charlson score [accessed June 13th, 2013]. Available from: URL: http://touchcalc.com/calculators/cci_js ‐ on line calculator (Date of access: 05/02/2014).
• 15. Hsu CM, Liang LL, Chang YT, Juang WC. Emergency department overcrowding: Quality improvement in a Taiwan Medical Center. J Formos Med Assoc 2019;118:86-93.
• 16. Hoot NR, Banuelos RC, Chathampally Y, Robinson DJ, Voronin BW, Chambers KA. Does crowding influence emergency department treatment time and disposition? J Am Coll Emerg Physicians Open. 2020;2:e12324.
• 17. McCarthy ML, Zeger SL, Ding R, Levin SR, Desmond JS, Lee J, et al. Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Ann Emerg Med. 2009;54:492-503.
• 18. Singer AJ, Thode HC, Viccellio P, Pines JM. The association between length of emergency department boarding and mortality. Acad Emerg Med. 2011;18:1324-9.
• 19. Baz U, Satar S, Kozacı N, Acikalin A, Gulen M, Karakurt U. Geriatric patient admissions to emergency service. JAEM 2014;13:53-7.
• 20. Kekec Z, Koc F, Buyuk S. Review of Geriatric Patients Hospitalization in Emergency Department. Turk J Emerg Med. 2009;8: 21-4.
• 21. Svenson J, Besinger B, Stapczynski JS. Critical care of medical and surgical patients in the ED: Length of stay and initation of intensive care procedures. Am J Emerg Med. 1997;15:6547.
• 22. Green RS, Macintyre JK. Critical care in the emergency department: An assessment of the length of stay and invasive procedures performed on citically ill ED patients. Scand J Trauma Resusc Emerg Med. 2009;17:47.
• 23. Ramlakhan S, Qayyum H, Burke D, Brown R. The safety of emergency medicine. Emerg Med J. 2016;33:293-9.
• 24. Liu SW, Thomas SH, Gordon JA, Hamedani AG, Weissman JS. A pilot study examining undesirable events among emergency departmentboarded patients awaiting inpatient beds. Ann Emerg Med. 2009;54:381-5.
• 25. Verma A, Shishodia S, Jaiswal S, Sheikh WR, Haldar M, Vishen A, et al. Increased Length of Stay of Critically Ill Patients in the Emergency Department Associated with Higher In-hospital Mortality. Indian J Crit Care Med. 2021; 25:1221-5.
• 26. Maleki M, Fallah R, Riahi L, Delavari S, Rezaei S. Effectiveness ofFive-Level Emergency Severity Index Triage System Compared With Three-Level Spot Check: An Iranian Experience. Arch Trauma Res. 2015;4:e29214.
• 27. Hoot NR, LeBlanc LJ, Jones I, Levin SR, Zhou C, Gadd CS, et al. Forecasting Emergency Department Crowding: A Discrete Event Simulation. Ann Emerg Med. 2008;52:116-25.
• 28. Lauks J, Mramor B, Baumgartl K, Maier H, Nickel CH, Bingisser R. Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay. PLOS ONE. 2016;11:e0154372.
• 29. Yarmohammadian MH, Rezaei F, Haghshenas A, Tavakoli N. Overcrowding in emergency departments: A review of strategies to decrease future challenges. J Res Med Sci 2017;22:23.
• 30. Oray NC, Yanturalli S, Atilla R, Ersoy G, Topacoglu H. A New Model in Reducing Emergency Department Crowding: The Electronic Blockage System. Turk J Emerg Med. 2016;14:64-70.
• 31. Di Somma S, Paladino L, Vaughan L, Lalle I, Magrini L, Magnanti M. Overcrowding in emergency department: an international issue. Intern Emerg Med. 2015;10:171-5.