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Boarding admitted children in the emergency department impacts inpatient outcomes
1Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0110, USA. bekmeziana@peds.ucsf.edu
Insights
Emergency department boarding in children increases hospital costs and length of stay, particularly for low-acuity and surgical patients. This study found no direct link to mortality but noted readmission risks for surgical cases.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Management
- Health Services Research
Background:
- Emergency Department (ED) boarding, defined as the time admitted patients spend in the ED awaiting an inpatient bed, is a significant operational challenge.
- Prolonged ED boarding can negatively impact patient flow, resource allocation, and quality of care within hospitals.
- Understanding the downstream effects of ED boarding is crucial for optimizing hospital operations and patient outcomes.
Purpose of the Study:
- To investigate the association between pediatric patient boarding time in the ED and key hospital metrics.
- To quantify the impact of boarding time on healthcare costs, inpatient length of stay (LOS), mortality rates, and hospital readmissions.
- To identify specific patient subgroups disproportionately affected by ED boarding.
Main Methods:
- Retrospective analysis of 1,792 pediatric inpatients admitted through the ED at a major teaching hospital.
- Boarding time (hours) was the primary predictor variable, with adjustments for patient age, acuity, service type, and illness severity.
- Linear regression analyzed log-transformed cost and inpatient LOS; logistic regression examined mortality and 72-hour readmission rates.
Main Results:
- Mean ED boarding time was 5.1 hours, contributing to a mean inpatient LOS of 147 hours and costs of $9,893.
- Boarding time significantly correlated with increased healthcare costs (P < 0.001) and inpatient LOS (P = 0.01).
- Increased boarding time was linked to longer inpatient LOS in low-acuity patients (P = 0.008) and a higher probability of readmission for surgical patients (P = 0.01).
Conclusions:
- Extended ED boarding times negatively impact hospital costs and inpatient LOS for pediatric patients.
- Low-acuity pediatric patients experience disproportionately longer inpatient stays with increased boarding.
- Surgical patients with longer boarding times face a higher risk of readmission within 72 hours.
Objective:
This study aimed to assess the relationship between boarding of admitted children in the emergency department (ED) and cost, inpatient length of stay (LOS), mortality, and readmission.
Methods:
This was a retrospective study of 1,792 pediatric inpatients admitted through the ED and discharged from the hospital between February 20, 2007 and June 30, 2008 at a major teaching hospital with an annual ED volume of 40,000 adult and pediatric patients.The main predictor variable was boarding time (time from admission decision to departure for an inpatient bed, in hours). Covariates were patient age, payer group, times of ED and inpatient bed arrival, ED triage acuity, type of inpatient service, intensive care unit admission, surgery, and severity of inpatient illness. The main outcome measures, cost (dollars) and inpatient LOS (hours), were log-transformed and analyzed using linear regressions. Secondary outcomes, mortality and readmission to the hospital within 72 hours of discharge, were analyzed using logistic regression.
Results:
Mean ED LOS for admitted patients was 9.0 hours. Mean boarding time was 5.1 hours. Mean cost and inpatient LOS were $9893 and 147 hours, respectively. In general, boarding time was associated with cost (P < 0.001) and inpatient LOS (P = 0.01) but not with mortality or readmission. Longer boarding times were associated with greater inpatient LOS especially among patients triaged as low acuity (P = 0.008). In addition, longer boarding times were associated with greater probability of being readmitted among patients on surgical services (P = 0.01).
Conclusions:
Among low-acuity and surgical patients, longer boarding times were associated with longer inpatient LOS and more readmissions, respectively.
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