Early Clinical Deterioration Among Emergency Department Boarders: A Retrospective Analysis

Area of Science:

• Emergency Medicine
• Patient Safety
• Clinical Deterioration

Background:

• Emergency department (ED) boarding, defined as patients admitted but awaiting an inpatient bed, is a growing concern.
• Understanding the risks associated with ED boarding is crucial for patient safety and hospital operations.

Purpose of the Study:

• To determine the incidence of early clinical deterioration in patients boarding in the ED.
• To identify factors associated with this deterioration, including boarding duration.

Main Methods:

• Retrospective study of adult patients admitted to internal medicine or subspecialty services.
• Analysis of data from a 5-hospital academic health system between January 2018 and June 2024.
• Logistic regression used to identify predictors of early clinical deterioration within 48 hours of admission order.

Main Results:

• 3.6% of 173,168 patients experienced early clinical deterioration, with 45% occurring while still boarding in the ED.
• Each excess hour of boarding was associated with a 0.8% increased risk of overall deterioration and a 2.4% increased risk of ED-based deterioration.
• Independent predictors included longer boarding time, academic safety-net hospital care, overnight admission, and elevated lactate levels. Mortality was higher in deteriorating patients (13.0% vs 3.9%).

Conclusions:

• Early clinical deterioration is a significant risk for patients experiencing ED boarding.
• Increased boarding duration is independently associated with a higher likelihood of clinical deterioration.
• These findings emphasize the critical patient safety risks associated with ED boarding.