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Impact of boarders in the emergency department
Kee Liem Terence Chong1, Jia Min Laura Tan1, Hui Cheng Tan2
1Department of Emergency Medicine, Sengkang General Hospital, Singapore.
Insights
Hospital boarding, where admitted patients wait in the emergency department (ED), significantly impacts patient care and staff well-being. Increased boarding correlates with longer wait times, more medical errors, and reduced staff satisfaction.
Area of Science:
- Emergency Medicine
- Hospital Administration
- Patient Flow Management
Background:
- Boarders are admitted patients awaiting inpatient beds in the emergency department (ED).
- Understanding the impact of boarding on ED operations is crucial for healthcare management.
Purpose of the Study:
- To investigate the correlation between the number of ED boarders and key outcome measures.
- To assess the impact of boarding on patient care effectiveness, safety, experience, and staff well-being.
Main Methods:
- A retrospective study design was employed.
- Pearson's correlation or Spearman's rho was used to analyze data.
- The number of boarders was correlated with various outcome metrics.
Main Results:
- A strong positive correlation was found between the number of boarders and increased wait times for triage and consultations.
- Boarding significantly correlated with delays in diagnostic tests (urinary, CT) and treatment administration (analgesia, antibiotics, IV fluids).
- Higher numbers of boarders were associated with increased medical errors, reduced patient compliments, and increased medical leave for staff.
Conclusions:
- Hospital boarding negatively affects ED efficiency and patient safety.
- Inadequate space and inefficient workflows due to boarding compromise timely and safe emergency care delivery.
Introduction:
Boarders refer to patients who have been admitted to the hospital but remain in the emergency department (ED) while waiting for an available inpatient bed. We aimed to examine the correlations between the number of boarders and outcome measures, including effectiveness of patient care, patient safety, efficiency of patient care, patient experience and staff well-being in the ED.
Methods:
A retrospective study was carried out. Correlations between the number of boarders and outcome measures were assessed using Pearson's correlation (r) or Spearman's rho (ρ).
Results:
The average number of boarders correlated strongly with these outcomes: wait times for triage (r = 0.883, P < 0.001); consult among P2 (urgent) (r = 0.829, P < 0.001) and P3 (ambulatory) patients (r = 0.825, P < 0.001); urinary test (r = 0.562, P < 0.001) and computed tomography (r = 0.733, P < 0.001); time taken for administration of analgesia (r = 0.960, P < 0.001), antibiotics (r = 0.828, P < 0.001) and intravenous fluids (r = 0.872, P < 0.001); and the length of stay for admitted patients (r = 0.995, P < 0.001) and discharged patients (r = 0.797, P < 0.001). Additionally, medical errors (ρ = 0.646, P < 0.001), compliments (ρ = 0.520, P = 0.006), patients who were triaged but did not go through consult (ρ = 0.848, P < 0.001), as well as medical leave taken by doctors (r = 0.626, P = 0.001) and nurses (r = 0.815, P < 0.001) strongly correlated with the average number of boarders in the ED.
Conclusion:
Boarders lead to insufficient space and inefficient work processes, which compromise the delivery of emergency care in a timely and safe manner for patients in EDs.
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