Improving Documentation for Boarded Patients: A Quality Improvement Initiative in a Single Emergency Department

Emergency department boarding, where admitted patients remain in the emergency department while awaiting inpatient beds, is a safety concern associated with adverse outcomes. This quality improvement initiative aimed to improve the timeliness and completeness of nursing documentation for boarded patients at a level II trauma center.

A pretest-posttest design, guided by the Model for Improvement, was implemented over 8 weeks. A Boarded Patient Assessment Documentation guideline was developed to standardize documentation in 5 key nursing assessment areas. Emergency nurses received education via a learning module and ongoing reinforcement through posters and shift huddles. Documentation adherence was measured through retrospective chart reviews. Wilcoxon rank-sum tests were used to compare nurses' confidence levels in documenting care for boarded patients before and after the intervention, as collected through anonymous surveys.

Of 59 emergency nurses, 84.7% completed the educational module. Post-intervention documentation of vital signs and allergies consistently met or exceeded the hospital's 80% target. Fall risk documentation reached the benchmark intermittently, while head-to-toe and skin assessment documentation remained below target, particularly during weeks of higher boarding volumes. Nurse confidence improved significantly for vital signs, skin, and allergy documentation, but gains were less pronounced for fall and head-to-toe assessments.

Implementing a Boarded Patient Assessment Documentation guideline improved nursing documentation and confidence for boarded patients in the emergency department, especially in vital signs, skin, and allergy assessments. Further strategies, including electronic health record prompts, are recommended to support ongoing adherence and broader dissemination of best practices.