The Boarders in the Emergency Department (BED) study.

Area of Science:

• Emergency Medicine
• Healthcare Management
• Infectious Disease Epidemiology

Background:

• Overcrowding in emergency departments (EDs) due to patients awaiting hospital admission, known as boarding, poses significant challenges.
• Boarding impacts patient outcomes, including mortality and infection rates, and affects ED operational efficiency.

Purpose of the Study:

• To investigate the effects of ED boarding on patient mortality.
• To assess the association between boarding and the likelihood of methicillin-resistant Staphylococcus aureus (MRSA) diagnosis.
• To evaluate the impact of boarding on ED efficiency metrics, such as time to medical assessment and patients leaving without being seen (LWBS).

Main Methods:

• A retrospective cohort analysis was conducted using data from all emergency department admissions.
• Information was accessed and integrated from multiple databases via the Diver Solution software.

Main Results:

• The average number of patients boarding in the ED at 09:00 was 20.4, with an average boarding duration of 16.1 hours.
• Increased ED attendances correlated with longer wait times for medical assessment and a higher number of patients leaving without being seen (LWBS).
• Elderly patients experienced longer admission waits and had the highest mortality and MRSA diagnosis rates.

Conclusions:

• Keeping patients requiring hospital admission in the ED (boarding) is detrimental to patient care and outcomes.
• The findings underscore the urgent need for a systemic response to alleviate ED boarding and improve patient flow.