Adverse Events in Emergency Department Boarding: A Systematic Review

Abstract

Background Overcrowding in emergency departments (EDs) is a worldwide challenge. As a result of the increased demand for EDs, slow internal patient flow, and unavailability of hospital beds, patients are kept in the corridors, causing a boarding effect. Studies have associated boarding in EDs with unfavorable clinical outcomes and adverse events. Thus, the purpose of this systematic review was to describe the effects of ED boarding on the occurrence of adverse events. Design We followed the Meta‐Analysis of Observational Studies in Epidemiology checklist and registered this systematic review with PROSPERO (CRD42020117915). Methods Literature searches were performed using the databases PubMed, Scopus, Latin American and Caribbean Center on Health Sciences Information (LILACS), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane, as well as Google Scholar, OpenThesis, and the Brazilian Digital Library of Theses and Dissertations from September to November 2019. Cohort or case control studies that evaluated the occurrence of adverse events in patients who remained in an ED, waiting for a hospital bed, were included in the review. Results Seven studies met our eligibility criteria. Boarding in EDs may be related to a reduction in the quality of care, resulting in unfavorable clinical outcomes and adverse events. Conclusions Boarding in EDs may be related to increases in adverse incidents and events. Clinical Relevance The evidence in this review suggests that ED boarding increases the occurrence of unfavorable outcomes and identifies important considerations for future research.

Impact of emergency department length of stay on in-hospital mortality: a retrospective cohort study

“…The mortality increase associated with long ED-LOS may be due to delayed urgent care requiring admission to specialised units and to quality care impairment of patients boarded in the ED. Long stays in the ED while awaiting in-hospital admission increases the risk of adverse events [25] such as forgetting drug administration or control blood sampling in patients presenting with chest pain, respiratory infection or cellulitis [26,27], and is associated with patient dissatisfaction [28]. Prolonged ED-LOS ≥ 12 h is independently associated with hospital-acquired pressure ulcers [29].…”

A Novel Orderset Driven Emergency Department Atrial Fibrillation Algorithm to Increase Discharge and Risk-appropriate Anticoagulation

“…This is especially important in a pandemic era where inpatient beds are a limited commodity and ED crowding due to ED inpatient boarding is rampant throughout the country, likely contributing to worse outcomes for those in need of hospital admission. 24,25 Quality order sets could be an efficient way to bundle care pathways and encourage appropriate risk-factor stratification, treatment, and follow up for patients with AF. 16,26 Future work to explore the generalizability and robustness of our results is needed and currently underway in our health system.…”

‘Corridor care’ in the emergency department: managing patient care in non-clinical areas safely and efficiently

“…While it has been proposed that small numbers of patients are instead boarded in corridors at their destination ward instead of the ED, this is not common practice in many hospitals, despite being supported by the Royal College of Emergency Medicine (RCEM 2015). A systematic review by Rocha et al (2021) identified that all-cause mortality increases after two hours of boarding, due to a reduced quality of care and increased likelihood of missed or delayed treatments. Furthermore, these patients require a physical space to be monitored and may not be ambulatory.…”