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      Patients Would Prefer Ward to Emergency Department Boarding While Awaiting an Inpatient Bed

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      Author(s): , MB, BCh, MSc * , ,
      Publication date (Electronic):
      Journal: The Journal of Emergency Medicine
      Publisher: Elsevier Inc.
      Keywords: boarding, overcrowding, Emergency Department

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          Abstract

          Boarding of admitted patients in the Emergency Department (ED), rather than in inpatient care areas, is widespread. We surveyed boarded patients, patients without a disposition, and visitors at a county hospital ED serving a mixed urban and rural population. Subjects were asked “If you needed to be admitted to the hospital but no inpatient bed is available, would you prefer to be kept in an ER hallway or a hallway on an inpatient ward?” Boarded patients said they would prefer ward to ED boarding, 117/213 (54.9%; 95% confidence interval [CI] 48.0%–61.7%). Patients without a disposition 314/477 (65.8%; 95% CI 61.4%–70.0%) and visitors 370/532 (69.5%; 95% CI 65.4%–73.4%) stated a preference for ward boarding in 314/477 (65.8%; 95% CI 61.4%–70.0%) and in 370/532 (69.5%; 95% CI 65.4%–73.4%), respectively. Common reasons for preferring inpatient ward boarding were privacy concerns and reduced noise levels. Those preferring ED boarding valued easy access to a doctor.

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          The effect of hospital occupancy on emergency department length of stay and patient disposition.

          George Wells, Myung Jin Lee, Carl van Colen … (2003)
          Emergency department (ED) overcrowding is a common problem. Despite a widespread belief that low hospital bed availability contributes to ED overcrowding, there are few data demonstrating this effect. To identify the effect of hospital occupancy on ED length of stay for admitted patients and patient disposition. This was an observational study design using administrative data at a 500-bed acute care teaching hospital. All patients presenting to the ED between April 1993 and June 1999 were included in the study. The predictor variable was daily hospital occupancy. Outcome measures included daily ED length of stay for admitted patients, daily consultation rate, and daily admission rate. The models controlled for the average daily age of ED patients and the average daily "arrival density" index, which adjusts for patient volume and clustering of patient arrivals. The average hospital occupancy was 89.7%. On average 155 patients visited the ED daily; 21% were referred to hospital physicians and 19% were admitted. The median ED length of stay for admitted patients was 5 hours 54 minutes (interquartile range 5 hr 12 min to 6 hr 42 min). Daily ED length of stay for admitted patients increased 18 minutes (95% CI = 12 to 24) when there was an absolute increase in occupancy of 10%. The ED length of stay appeared to increase extensively when hospital occupancy exceeded a threshold of 90%. Consultation and admission rates were not influenced by hospital occupancy. Increased hospital occupancy is strongly associated with ED length of stay for admitted patients. Increasing hospital bed availability might reduce ED overcrowding.
          Article 0 comments Cited 82 times – based on 0 reviews     Review now
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            Frequent overcrowding in U.S. emergency departments.

            Robert Derlet, John Richards, Richard Kravitz (2001)
            To describe the definition, extent, and factors associated with overcrowding in emergency departments (EDs) in the United States as perceived by ED directors. Surveys were mailed to a random sample of EDs in all 50 states. Questions included ED census, frequency, impact, and determination of overcrowding. Respondents were asked to rank perceived causes using a five-point Likert scale. Of 836 directors surveyed, 575 (69%) responded, and 525 (91%) reported overcrowding as a problem. Common definitions of overcrowding (>70%) included: patients in hallways, all ED beds occupied, full waiting rooms >6 hours/day, and acutely ill patients who wait >60 minutes to see a physician. Overcrowding situations were similar in academic EDs (94%) and private hospital EDs (91%). Emergency departments serving populations < or =250,000 had less severe overcrowding (87%) than EDs serving larger areas (96%). Overcrowding occurred most often several times per week (53%), but 39% of EDs reported daily overcrowding. On a 1-5 scale (+/-SD), causes of overcrowding included high patient acuity (4.3 +/- 0.9), hospital bed shortage (4.2 +/- 1.1), high ED patient volume (3.8 +/- 1.2), radiology and lab delays (3.3 +/- 1.2), and insufficient ED space (3.3 +/- 1.3). Thirty-three percent reported that a few patients had actual poor outcomes as a result of overcrowding. Episodic, but frequent, overcrowding is a significant problem in academic, county, and private hospital EDs in urban and rural settings. Its causes are complex and multifactorial.
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              Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS).

              Todd Nick, Jeanine Arndahl, Thomas O Stair … (2003)
              No single universal definition of emergency department (ED) overcrowding exists. The authors hypothesize that a previously developed site-sampling form for academic ED overcrowding is a valid model to quantify overcrowding in academic institutions and can be used to develop a validated short form that correlates with overcrowding. A 23-question site-sampling form was designed based on input from academic physicians at eight medical schools representative of academic EDs nationwide. A total of 336 site-samplings at eight academic medical centers were conducted at 42 computer-generated random times over a three-week period by independent observers at each site. These sampling times ranged from very slow to severely overcrowded. The outcome variable was the degree of overcrowding as assessed by the charge nurse and ED physicians. The full model consisted of objective data that were obtained by counting the number of patients, determining patients' waiting times, and obtaining information from registration, triage, and ancillary services. Specific objective data were indexed to site-specific demographics. The outcome and objective data were compared using a multiple linear regression to determine predictive validity of the full model. A five-question reduced model was calculated using a backward stepdown procedure. Predictive validity and relationships between the outcome and objective data were assessed using a mixed-effects linear regression model, treating center as random effect. Overcrowding occurred 12% to 73% of the time (mean, 35%), with two hospitals being overcrowded more than 50% of the time. Comparison of objective and outcome data resulted in an R(2) of 0.49 (p < 0.001), indicating a good degree of predictive validity. A reduced five-question model predicted the full model with 88% accuracy. Overcrowding varied widely between academic centers during the study period. Results of a five-question reduced model are valid and accurate in predicting the degree of overcrowding in academic centers.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Emerg Med
                Journal ID (iso-abbrev): J Emerg Med
                Title: The Journal of Emergency Medicine
                Publisher: Elsevier Inc.
                ISSN (Print): 0736-4679
                ISSN (Electronic): 0736-4679
                Publication date PMC-release: 21 February 2008
                Publication date (Print): February 2008
                Publication date (Electronic): 21 February 2008
                Volume: 34
                Issue: 2
                Pages: 221-226
                Affiliations
                Department of Emergency Medicine, Kern Medical Center, Bakersfield, California
                Author notes
                [* ] Reprint Address: Paul Walsh, mb, bch, msc, Department of Emergency Medicine, Kern Medical Center, 1830 Flower Street, Bakersfield, CA 93305
                Article
                Publisher ID: S0736-4679(07)00372-1
                DOI: 10.1016/j.jemermed.2007.05.012
                PMC ID: 7125793
                PubMed ID: 17976825
                SO-VID: 58517d2f-e5b4-4bee-a13f-3702df3a530d
                Copyright statement: Copyright © 2008 Elsevier Inc. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 19 December 2005
                Date revision received : 30 June 2006
                Date accepted : 13 November 2006
                Categories
                Subject: Article

                Keywords: boarding,overcrowding,emergency department
                Data availability:
                Keywords: boarding, overcrowding, emergency department

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