Emergency Department Overcrowding and Inpatient Boarding: A Statewide Glimpse in Time

Authors

  • Brent M. Felton DO,

    1. From the Department of Emergency Medicine (BMF, EJR), Michigan State University, East Lansing, MI; Emergency Medicine, Bristol Regional Medical Center (CNK), Bristol, TN; and Emergency Medicine, Willis-Knighton Medical Center (GAL), Shreveport, LA.
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  • Earl J. Reisdorff MD,

    1. From the Department of Emergency Medicine (BMF, EJR), Michigan State University, East Lansing, MI; Emergency Medicine, Bristol Regional Medical Center (CNK), Bristol, TN; and Emergency Medicine, Willis-Knighton Medical Center (GAL), Shreveport, LA.
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  • Christopher N. Krone MD,

    1. From the Department of Emergency Medicine (BMF, EJR), Michigan State University, East Lansing, MI; Emergency Medicine, Bristol Regional Medical Center (CNK), Bristol, TN; and Emergency Medicine, Willis-Knighton Medical Center (GAL), Shreveport, LA.
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  • Gus A. Laskaris MD

    1. From the Department of Emergency Medicine (BMF, EJR), Michigan State University, East Lansing, MI; Emergency Medicine, Bristol Regional Medical Center (CNK), Bristol, TN; and Emergency Medicine, Willis-Knighton Medical Center (GAL), Shreveport, LA.
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  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: Michael Mello, MD.

Address for correspondence and reprints: Brent Felton, DO; e-mail: feltonbr@gmail.com.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:1386–1391 © 2011 by the Society for Academic Emergency Medicine

Abstract

Objectives:  This was a point-prevalence study designed to quantify the magnitude of emergency department (ED) overcrowding and inpatient boarding. Every ED in Michigan was surveyed at a single point in time on a Monday evening. Given the high patient volumes on Monday evenings, the effect on inpatient boarding the next morning was also reviewed.

Methods:  All 134 EDs within the state of Michigan were contacted and surveyed on Monday evening, March 16, 2009, over a single hour and again the following morning. Questions included data on annual census, bed number, number of admitted patients within the ED, ambulance diversion, and ED length of stay.

Results:  Data were obtained from 109 of the 134 (81%) hospitals on Monday evening and 99 (74%) on Tuesday morning. There was no difference in annual visits or ED size between participating and nonparticipating EDs. Forty-seven percent of EDs were boarding inpatients on Monday evening, compared with 30% on Tuesday morning. The mean estimated boarding times were 3.7 hours (Monday evening) and 7.2 hours (Tuesday morning). Twenty-four percent of respondents met the definition of overcrowded during sampling times. There was a significant relationship between inpatient boarding and ED overcrowding (p < 0.001). Only three EDs were actively diverting ambulances.

Conclusions:  In this study on a single Monday evening, 47% of EDs in Michigan were actively boarding inpatients, while 24% were operating beyond capacity. On the following morning (Tuesday), EDs had fewer boarded inpatients than on Monday evening. However, these boarded inpatients remained in the ED for a significantly longer duration.

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