Mitigating ED boarding during surge conditions: A multidisciplinary resilience model at a tertiary center epicenter

Emergency department (ED) overcrowding and boarding intensified during the COVID-19 pandemic. We evaluated the association of a multidisciplinary rapid response team (RRT) with ED boarding during the 2021 surge in New Taipei City, Taiwan.

A retrospective quality improvement study was conducted at a 1058-bed, newly established tertiary referral hospital situated at the epicenter of the pandemic in Taiwan. In May 2021, an RRT implemented three strategies: (1) diversion of mild COVID-19 cases to quarantine centers via telemedicine, (2) real-time business intelligence (BI) dashboard monitoring for bed allocation, and (3) an ED-based outpatient parenteral antimicrobial therapy (OPAT) program. Primary outcomes were ED boarding time and the proportion of stays exceeding 48 h.

Among 43,368 ED visits in 2021, median ED boarding time decreased from 58.4 h (IQR 42.2-76.8) during the pre-intervention period to 6.2 h (IQR 4.1-11.5) following RRT implementation (P < .001). The proportion of patients boarding >48 h decreased from 5.09% in June to 0.16% in December 2021.

A coordinated, multidisciplinary approach integrating digital monitoring, community diversion, and alternative treatment pathways effectively maintained ED operational resilience during a public health crisis. This model offers an adaptable operational strategy for managing acute capacity strain and maintaining throughput during future epidemic surges.