The impact of hospital boarding on the emergency department waiting room.
crowding
emergency department boarding
emergency department wait times
hospital occupancy
length of stay
waiting room
Journal
Journal of the American College of Emergency Physicians open
ISSN: 2688-1152
Titre abrégé: J Am Coll Emerg Physicians Open
Pays: United States
ID NLM: 101764779
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
12
03
2020
revised:
22
04
2020
accepted:
27
04
2020
entrez:
4
11
2020
pubmed:
5
11
2020
medline:
5
11
2020
Statut:
epublish
Résumé
Patient boarding in the emergency department (ED) is a significant issue leading to increased morbidity/mortality, longer lengths of stay, and higher hospital costs. We examined the impact of boarding patients on the ED waiting room. Additionally, we determined whether facility type, patient acuity, time of day, or hospital occupancy impacted waiting rooms in 18 EDs across a large healthcare system. This was a retrospective multicenter study that included all ED encounters between January 1, 2018, and September 30, 2019. Encounters with missing Emergency Severity Index (ESI) level were excluded. ESI levels were defined as high (ESI 1,2), middle (ESI 3), and low (ESI 4,5). Spearman correlation coefficients measured the relationship between boarded patients and number of patients in ED waiting room. A multivariable mixed effects model identified drivers of this relationship. A total of 1,134,178 encounters were included. Spearman correlation coefficient was significant between number of patients in the ED waiting room and patient boarding (0.54). For every additional patient boarded/hour, the number of patients waiting/hour in the waiting room increased by 8% (95% confidence interval [CI] = 1.08-1.09). The number of patients waiting for a room/hour was 2.28 times higher for middle than for high acuity. The number of patients in waiting room slightly decreased as hospital occupancy increased (95% CI = 0.997-0.997). Number of patients in ED waiting room are directly related to boarding times and hospital occupancy. ED waiting room times should be considered as not just an ED operational issue, but an aspect of hospital throughput.
Sections du résumé
BACKGROUND
BACKGROUND
Patient boarding in the emergency department (ED) is a significant issue leading to increased morbidity/mortality, longer lengths of stay, and higher hospital costs. We examined the impact of boarding patients on the ED waiting room. Additionally, we determined whether facility type, patient acuity, time of day, or hospital occupancy impacted waiting rooms in 18 EDs across a large healthcare system.
METHODS
METHODS
This was a retrospective multicenter study that included all ED encounters between January 1, 2018, and September 30, 2019. Encounters with missing Emergency Severity Index (ESI) level were excluded. ESI levels were defined as high (ESI 1,2), middle (ESI 3), and low (ESI 4,5). Spearman correlation coefficients measured the relationship between boarded patients and number of patients in ED waiting room. A multivariable mixed effects model identified drivers of this relationship.
RESULTS
RESULTS
A total of 1,134,178 encounters were included. Spearman correlation coefficient was significant between number of patients in the ED waiting room and patient boarding (0.54). For every additional patient boarded/hour, the number of patients waiting/hour in the waiting room increased by 8% (95% confidence interval [CI] = 1.08-1.09). The number of patients waiting for a room/hour was 2.28 times higher for middle than for high acuity. The number of patients in waiting room slightly decreased as hospital occupancy increased (95% CI = 0.997-0.997).
CONCLUSION
CONCLUSIONS
Number of patients in ED waiting room are directly related to boarding times and hospital occupancy. ED waiting room times should be considered as not just an ED operational issue, but an aspect of hospital throughput.
Identifiants
pubmed: 33145557
doi: 10.1002/emp2.12100
pii: EMP212100
pmc: PMC7593429
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1052-1059Informations de copyright
© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Emerg Med Australas. 2017 Aug;29(4):415-420
pubmed: 28378942
Ann Emerg Med. 2019 Mar;73(3):e23
pubmed: 30797309
Emerg Med Int. 2011;2011:840459
pubmed: 22235374
Am J Emerg Med. 2018 Sep;36(9):1534-1539
pubmed: 29310983
Acad Emerg Med. 2011 May;18(5):539-44
pubmed: 21545672
Health Aff (Millwood). 2012 Aug;31(8):1757-66
pubmed: 22869654
Emerg Med Australas. 2016 Apr;28(2):164-70
pubmed: 26845068
Acad Emerg Med. 2011 Dec;18(12):1324-9
pubmed: 22168198
Acad Emerg Med. 2010 Aug;17(8):813-23
pubmed: 20670318
Acad Emerg Med. 2007 Apr;14(4):332-7
pubmed: 17331916
BMC Emerg Med. 2017 Nov 9;17(1):34
pubmed: 29121883
J Emerg Med. 2013 Dec;45(6):942-6
pubmed: 24063879
West J Emerg Med. 2017 Jun;18(4):553-558
pubmed: 28611873
Ann Emerg Med. 2008 Jan;51(1):9-12, 12.e1-3
pubmed: 17490787
Med Care. 2018 May;56(5):436-440
pubmed: 29570120