The Effect of Hospital Boarding on Emergency Medicine Residency Productivity

Emergency department boarding has escalated to a crisis, impacting patient care, hospital finances, and physician burnout, and contributing to error. No prior studies have examined the effects of boarding hours on resident productivity. If boarding reduces productivity, it may have negative educational impacts. We investigated the effect of boarding on resident productivity as measured by patients per hour and hypothesized that increased boarding leads to decreased productivity.

This was a retrospective study at a quaternary, urban, academic Level I trauma center from 2017-2021 with a three-year emergency medicine residency of 10-12 residents per year and annual volumes of 80,000-101,000. Boarding was defined as the time between an admission order and the patient leaving the ED. We created a multivariable mixed model with fixed covariates for year, month, day of week, resident experience, shift duration, total daily ED patients, and with residents as repeated measures. The effect of boarding was estimated after covarying out all other factors.

All variables included in the model were significantly associated with changes in productivity. Resident experience has the largest effect such that for each month of residency experience, a resident adds 0.012 patients per hour (95% confidence interval [CI] 0.010-0.014). Isolating the effect of boarding demonstrated that for every additional 100 hours of boarding, a resident's productivity decreased by 0.022 patients per hour (95% CI 0.016-0.028). In the study, the median daily boarding was 261 hours; if this were eliminated (assuming a resident completes 100 10-hour shifts annually), a resident could be expected to see 56.9 more patients per year (95% CI 40.7-73.1).

Hospital boarding significantly reduces resident productivity as measured by patients per hour. Further studies are warranted to determine the educational impact.