ED "hold" patients: is their care also being held?

Patient care should be governed by the same standards of care regardless of location within a hospital system. Little is known about adherence to standards of care for admitted patients who are "held" in the emergency department because of an unavailable inpatient bed. For example, is there a difference in the timeliness of nursing assessments and initial antibiotic administration for patients with pneumonia who are held in the emergency department compared with those who are directly admitted to an inpatient bed?

A descriptive comparison research design with 2 known groups ("ED hold" patients and "ED direct-admit" patients) was used. A convenience sample of 104 closed medical records was obtained from a Midwestern hospital for a retrospective chart audit.

Patients held in the emergency department had their blood pressure, pulse, respiratory rate, and oxygen saturation recorded with greater frequency compared with patients who were directly admitted. Directly admitted patients had their intake and output and their temperature noted with greater frequency. Although there was no statistically significant difference in the timeliness of respiratory assessments or antibiotic administration, antibiotics were delivered to the ED direct-admit group an average of 1 hour earlier than to the ED hold group.

When measuring only the frequency and/or timeliness of taking vital signs, recording intake and output, and administering antibiotics, there were statistical differences between "hold" patients and "direct-admit" patients. In some instances, ED "hold" patients actually received more timely assessment than did "direct-admit" patients. Direct-admit patients received antibiotics an average of 1 hour sooner. More studies are necessary to evaluate other aspects of care that may or may not be compromised when admitted patients are "held" in the emergency department.