Presented at the American College of Emergency Physicians Research Forum, September 2010, Las Vegas, NV.
Original Research Contribution
The Association Between Length of Emergency Department Boarding and Mortality
Article first published online: 13 DEC 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Special Issue: Proceedings of the 2011 AEM Consenus Conference: Interventions to Assure Quality in the Crowded Emergency Department Guest Editors: James R. Miner, MD Manish N. Shah, MD, MPH
Volume 18, Issue 12, pages 1324–1329, December 2011
How to Cite
Singer, A. J., Thode Jr, H. C., Viccellio, P. and Pines, J. M. (2011), The Association Between Length of Emergency Department Boarding and Mortality. Academic Emergency Medicine, 18: 1324–1329. doi: 10.1111/j.1553-2712.2011.01236.x
The authors have no relevant financial information or potential conflicts of interest to disclose.
Supervising Editor: Lowell Gerson, PhD.
- Issue published online: 13 DEC 2011
- Article first published online: 13 DEC 2011
- Received November 1, 2010; revision received December 29, 2010; accepted December 30, 2010.
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.
ACADEMIC EMERGENCY MEDICINE 2011; 18:1324–1329 © 2011 by the Society for Academic Emergency Medicine