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The association of duration of boarding in the emergency room and the outcome of patients admitted to the intensive care unit.
BMC Emerg Med. 2017 11 09; 17(1):34.BE

Abstract

BACKGROUND

The demand for critical care beds is increasing out of proportion to bed availability. As a result, some critically ill patients are kept in the Emergency Department (ED boarding) awaiting bed availability. The aim of our study is to examine the impact of boarding in the ED on the outcome of patients admitted to the Intensive Care Unit(ICU).

METHODS

This was a retrospective analysis of ICU data collected prospectively at King Abdulaziz Medical City, Riyadh from ED between January 2010 and December 2012 and all patients admitted during this time were evaluated for their duration of boarding. Patients were stratified into three groups according to the duration of boarding from ED. Those admitted less than 6 h were classified as Group I, between 6 and 24 h, Group II and more than 24 h as Group III. We carried out multivariate analysis to examine the independent association of boarding time with the outcome adjusting for variables like age, sex, APACHE, Mechanical ventilation, Creatinine, Platelets, INR.

RESULTS

During the study period, 940 patients were admitted from the ED to ICU, amongst whom 227 (25%) were admitted to ICU within 6 h, 358 (39%) within 6-24 h and 355 (38%) after 24 h. Patients admitted to ICU within 6 h were younger [48.7 ± 22.2(group I) years, 50.6 ± 22.6 (group II), 58.2 ± 20.9 (group III) (P = 0.04)]with less mechanical ventilation duration[5.9 ± 8.9 days (Group I), 6.5 ± 8.1 (Group II) and 10.6 ± 10.5 (Group III), P = 0.04]. There was a significant increase in hospital mortality [51(22.5), 104(29.1), 132(37.2), P = 0.0006) and the ICU length of stay(LOS) [9.55 days (Group I), 9.8 (Group II) and 10.6 (Group III), (P = 0.002)] with increase in boarding duration. In addition, the delay in admission was an independent risk factor for ICU mortality(OR for group III vs group I is 1.90, P = 0.04) and hospital mortality(OR for group III vs Group I is 2.09, P = 0.007).

CONCLUSION

Boarding in the ED is associated with higher mortality. This data highlights the importance of this phenomenon and suggests the need for urgent measures to reduce boarding and to improve patient flow.

Links

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Authors+Show Affiliations

Al-Qahtani S
Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Saudi Arabia. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Alsultan A
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Haddad S
Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Saudi Arabia.
Alsaawi A
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Alshehri M
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Alsolamy S
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Emergency Medicine and Intensive Care Department, College of Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
Felebaman A
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Obstetrics and Gynecology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Tamim HM
Department of Internal Medicine, American University of Beirut- Medical Center, Beirut, Lebanon.
Aljerian N
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Al-Dawood A
Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Saudi Arabia. aldawooda@hotmail.com. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. aldawooda@hotmail.com. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. aldawooda@hotmail.com.
Arabi Y
Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Saudi Arabia. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.

MeSH

Emergency Service, HospitalFemaleHospital MortalityHumansIntensive Care UnitsLength of StayMaleMiddle AgedPatient AdmissionRetrospective StudiesTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29121883

Citation

Al-Qahtani, Saad, et al. "The Association of Duration of Boarding in the Emergency Room and the Outcome of Patients Admitted to the Intensive Care Unit." BMC Emergency Medicine, vol. 17, no. 1, 2017, p. 34.
Al-Qahtani S, Alsultan A, Haddad S, et al. The association of duration of boarding in the emergency room and the outcome of patients admitted to the intensive care unit. BMC Emerg Med. 2017;17(1):34.
Al-Qahtani, S., Alsultan, A., Haddad, S., Alsaawi, A., Alshehri, M., Alsolamy, S., Felebaman, A., Tamim, H. M., Aljerian, N., Al-Dawood, A., & Arabi, Y. (2017). The association of duration of boarding in the emergency room and the outcome of patients admitted to the intensive care unit. BMC Emergency Medicine, 17(1), 34. https://doi.org/10.1186/s12873-017-0143-4
Al-Qahtani S, et al. The Association of Duration of Boarding in the Emergency Room and the Outcome of Patients Admitted to the Intensive Care Unit. BMC Emerg Med. 2017 11 9;17(1):34. PubMed PMID: 29121883.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association of duration of boarding in the emergency room and the outcome of patients admitted to the intensive care unit. AU - Al-Qahtani,Saad, AU - Alsultan,Abdullah, AU - Haddad,Samir, AU - Alsaawi,Abdulmohsen, AU - Alshehri,Moeed, AU - Alsolamy,Sami, AU - Felebaman,Afef, AU - Tamim,Hani M, AU - Aljerian,Nawfal, AU - Al-Dawood,Abdulaziz, AU - Arabi,Yaseen, Y1 - 2017/11/09/ PY - 2017/01/27/received PY - 2017/10/18/accepted PY - 2017/11/11/entrez PY - 2017/11/11/pubmed PY - 2018/6/6/medline KW - Critical care KW - Critical illness KW - ED boarding KW - Emergency service, hospital KW - Hospital mortality KW - ICU KW - Length of stay KW - Retrospective studies KW - Saudi Arabia SP - 34 EP - 34 JF - BMC emergency medicine JO - BMC Emerg Med VL - 17 IS - 1 N2 - BACKGROUND: The demand for critical care beds is increasing out of proportion to bed availability. As a result, some critically ill patients are kept in the Emergency Department (ED boarding) awaiting bed availability. The aim of our study is to examine the impact of boarding in the ED on the outcome of patients admitted to the Intensive Care Unit(ICU). METHODS: This was a retrospective analysis of ICU data collected prospectively at King Abdulaziz Medical City, Riyadh from ED between January 2010 and December 2012 and all patients admitted during this time were evaluated for their duration of boarding. Patients were stratified into three groups according to the duration of boarding from ED. Those admitted less than 6 h were classified as Group I, between 6 and 24 h, Group II and more than 24 h as Group III. We carried out multivariate analysis to examine the independent association of boarding time with the outcome adjusting for variables like age, sex, APACHE, Mechanical ventilation, Creatinine, Platelets, INR. RESULTS: During the study period, 940 patients were admitted from the ED to ICU, amongst whom 227 (25%) were admitted to ICU within 6 h, 358 (39%) within 6-24 h and 355 (38%) after 24 h. Patients admitted to ICU within 6 h were younger [48.7 ± 22.2(group I) years, 50.6 ± 22.6 (group II), 58.2 ± 20.9 (group III) (P = 0.04)]with less mechanical ventilation duration[5.9 ± 8.9 days (Group I), 6.5 ± 8.1 (Group II) and 10.6 ± 10.5 (Group III), P = 0.04]. There was a significant increase in hospital mortality [51(22.5), 104(29.1), 132(37.2), P = 0.0006) and the ICU length of stay(LOS) [9.55 days (Group I), 9.8 (Group II) and 10.6 (Group III), (P = 0.002)] with increase in boarding duration. In addition, the delay in admission was an independent risk factor for ICU mortality(OR for group III vs group I is 1.90, P = 0.04) and hospital mortality(OR for group III vs Group I is 2.09, P = 0.007). CONCLUSION: Boarding in the ED is associated with higher mortality. This data highlights the importance of this phenomenon and suggests the need for urgent measures to reduce boarding and to improve patient flow. SN - 1471-227X UR - https://www.unboundmedicine.com/medline/citation/29121883/The_association_of_duration_of_boarding_in_the_emergency_room_and_the_outcome_of_patients_admitted_to_the_intensive_care_unit_ DB - PRIME DP - Unbound Medicine ER -