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Evaluation of the risk factors associated with emergency department boarding: A retrospective cross-sectional study
Yousef Nouri1, Changiz Gholipour2, Javad Aghazadeh3
1Department of Emergency, Urmia University of Medical Sciences, Urmia, Iran.
Insights
Emergency department boarding affects over 21% of patients, particularly older females and those needing surgery. This study characterizes boarding rates, causes, and consequences at Imam Khomeini Hospital.
Area of Science:
- Emergency Medicine
- Healthcare Management
- Patient Flow Optimization
Background:
- Boarding in emergency departments (EDs) is a significant issue linked to adverse healthcare outcomes.
- Imam Khomeini Hospital in Urmia, Iran, faces overcrowding and high patient volumes, necessitating an analysis of ED boarding.
- Understanding boarding is crucial for improving patient care and hospital efficiency.
Purpose of the Study:
- To determine the rate, causes, and consequences of boarding in the ED of Imam Khomeini Hospital.
- To identify patient demographics and clinical factors associated with ED boarding.
- To analyze the impact of boarding on patient outcomes and hospital operations.
Main Methods:
- Retrospective analysis of 1608 patient records from August 2017 to August 2018.
- Boarding defined as delayed transfer to a ward for ≥2 hours post-admission order.
- Data collected included demographics, triage levels (Emergency Severity Index), mortality, and patient presentation times.
Main Results:
- A boarding rate of 21.1% was observed, with a mean boarding time of 13.70 hours.
- Boarding was more prevalent in older females, patients requiring intensive care, and those with lower triage scores.
- Surgical, orthopedic, neurosurgery, and neurology departments experienced the highest boarding rates.
Conclusions:
- ED boarding disproportionately affects older females and patients requiring surgical care.
- Boarding is significantly influenced by downstream ward capacity and patient disposition.
- Addressing boarding is essential for enhancing ED efficiency and patient safety.
Purpose:
Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center.
Methods:
All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test.
Results:
Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age.
Conclusion:
The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.
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