The potential for patient-reported data and narratives to improve quality during emergency department boarding

Emergency department (ED) boarding, the holding of admitted patients in the ED due to unavailable inpatient beds, is a growing challenge linked to poorer patient outcomes. Traditional patient experience surveys, such as the ED Consumer Assessment of Healthcare Providers and Systems (ED CAHPS), exclude insights from boarded patients, whose experiences could inform quality improvement efforts. We collected data using the patient-reported outcomes to improve diagnostic experience in the ED instrument from all patients, whether discharged or admitted. Early findings show that longer ED stays correlate with lower patient-reported diagnostic quality scores, with the highest quartile of stay durations averaging 3.79 out of 5 compared to 4.10 in the lowest quartile. A separate nationwide survey of diagnostic experiences, which did not specifically ask about EDs or wait times, also highlighted the impact of long ED stays. Patient narratives emphasized the need for better communication during boarding, such as explaining the reasons for admission. These findings suggest that including boarded patients in ED CAHPS' sampling criteria and incorporating open-ended questions could provide valuable insights for improving ED boarding practices. This commentary emphasizes the value of patient-driven data in identifying actionable solutions to mitigate the challenges of ED boarding.