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The association between length of emergency department boarding and mortality.
Acad Emerg Med. 2011 Dec; 18(12):1324-9.AE

Abstract

OBJECTIVES

Emergency department (ED) boarding has been associated with several negative patient-oriented outcomes, from worse satisfaction to higher inpatient mortality rates. The current study evaluates the association between length of ED boarding and outcomes. The authors expected that prolonged ED boarding of admitted patients would be associated with higher mortality rates and longer hospital lengths of stay (LOS).

METHODS

This was a retrospective cohort study set at a suburban academic ED with an annual ED census of 90,000 visits. Consecutive patients admitted to the hospital from the ED and discharged between October 2005 and September 2008 were included. An electronic medical record (EMR) system was used to extract patient demographics, ED disposition (discharge, admit to floor), ED and hospital LOS, and in-hospital mortality. Boarding was defined as ED LOS 2 hours or more after decision for admission. Descriptive statistics were used to evaluate the association between length of ED boarding and hospital LOS, subsequent transfer to an intensive care unit (ICU), and mortality controlling for comorbidities.

RESULTS

There were 41,256 admissions from the ED. Mortality generally increased with increasing boarding time, from 2.5% in patients boarded less than 2 hours to 4.5% in patients boarding 12 hours or more (p < 0.001). Mean hospital LOS also showed an increase with boarding time (p < 0.001), from 5.6 days (SD ± 11.4 days) for those who stayed in the ED for less than 2 hours to 8.7 days (SD ± 16.3 days) for those who boarded for more than 24 hours. The increases were still apparent after adjustment for comorbid conditions and other factors.

CONCLUSIONS

Hospital mortality and hospital LOS are associated with length of ED boarding.

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Authors+Show Affiliations

Singer AJ
Department of Emergency Medicine, Stony Brook University, NY, USA. adam.singer@stonybrook.edu
Thode HC
No affiliation info available
Viccellio P
No affiliation info available
Pines JM
No affiliation info available

MeSH

Academic Medical CentersAdultAge FactorsAgedAnalysis of VarianceCohort StudiesConfidence IntervalsEmergency MedicineEmergency Service, HospitalFemaleHospital MortalityHumansLength of StayMaleMiddle AgedMultivariate AnalysisOdds RatioOutcome Assessment, Health CarePatient AdmissionPatient TransferRetrospective StudiesRisk AssessmentSex FactorsTime Factors

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22168198

Citation

Singer, Adam J., et al. "The Association Between Length of Emergency Department Boarding and Mortality." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 18, no. 12, 2011, pp. 1324-9.
Singer AJ, Thode HC, Viccellio P, et al. The association between length of emergency department boarding and mortality. Acad Emerg Med. 2011;18(12):1324-9.
Singer, A. J., Thode, H. C., Viccellio, P., & Pines, J. M. (2011). The association between length of emergency department boarding and mortality. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 18(12), 1324-9. https://doi.org/10.1111/j.1553-2712.2011.01236.x
Singer AJ, et al. The Association Between Length of Emergency Department Boarding and Mortality. Acad Emerg Med. 2011;18(12):1324-9. PubMed PMID: 22168198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association between length of emergency department boarding and mortality. AU - Singer,Adam J, AU - Thode,Henry C,Jr AU - Viccellio,Peter, AU - Pines,Jesse M, PY - 2011/12/16/entrez PY - 2011/12/16/pubmed PY - 2012/5/4/medline SP - 1324 EP - 9 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 18 IS - 12 N2 - OBJECTIVES: Emergency department (ED) boarding has been associated with several negative patient-oriented outcomes, from worse satisfaction to higher inpatient mortality rates. The current study evaluates the association between length of ED boarding and outcomes. The authors expected that prolonged ED boarding of admitted patients would be associated with higher mortality rates and longer hospital lengths of stay (LOS). METHODS: This was a retrospective cohort study set at a suburban academic ED with an annual ED census of 90,000 visits. Consecutive patients admitted to the hospital from the ED and discharged between October 2005 and September 2008 were included. An electronic medical record (EMR) system was used to extract patient demographics, ED disposition (discharge, admit to floor), ED and hospital LOS, and in-hospital mortality. Boarding was defined as ED LOS 2 hours or more after decision for admission. Descriptive statistics were used to evaluate the association between length of ED boarding and hospital LOS, subsequent transfer to an intensive care unit (ICU), and mortality controlling for comorbidities. RESULTS: There were 41,256 admissions from the ED. Mortality generally increased with increasing boarding time, from 2.5% in patients boarded less than 2 hours to 4.5% in patients boarding 12 hours or more (p < 0.001). Mean hospital LOS also showed an increase with boarding time (p < 0.001), from 5.6 days (SD ± 11.4 days) for those who stayed in the ED for less than 2 hours to 8.7 days (SD ± 16.3 days) for those who boarded for more than 24 hours. The increases were still apparent after adjustment for comorbid conditions and other factors. CONCLUSIONS: Hospital mortality and hospital LOS are associated with length of ED boarding. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/22168198/The_association_between_length_of_emergency_department_boarding_and_mortality_ L2 - https://doi.org/10.1111/j.1553-2712.2011.01236.x DB - PRIME DP - Unbound Medicine ER -