An Empirical Assessment of Boarding and Quality of Care: Delays in Care Among Chest Pain, Pneumonia, and Cellulitis Patients

Liu, Shan W.; Chang, Yuchiao; Weissman, Joel S.; Griffey, Richard T.; Thomas, James M.; Nergui, Suvd; Hamedani, Azita G.; Camargo, Carlos A.; Singer, Sara J.

doi:10.1111/j.1553-2712.2011.01082.x

Cited by 46 publications

(36 citation statements)

References 44 publications

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“…However, as there is a paucity of literature on bedspacing itself, we feel that relevant inferences may be drawn from the Emergency Department (ED) overcrowding literature. Patients who remain in the ED after admission, but do not yet have an inpatient bed, have been referred to as “boarders.” Evidence suggests that boarders have increased lengths of stay, delays in home medication administration, and overall delays in medical care [5]-[9]. One study demonstrated an association with increased in-hospital mortality rates [10].…”

Section: Discussionmentioning

confidence: 99%

“…While bedspacing is a routine occurrence in many hospitals, it is unclear whether this practice compromises patient care. Evidence from similar patient populations who are physically separated from the medical team has shown that clinician-patient barriers can result in poorer quality of care [5]–[10]. As care needs may differ between GIM and non-GIM patients, non-GIM “host” services may have less experience with GIM patients, and ultimately, bedspaced patients may have compromised quality of care (for example, with poorer nursing adherence to quality measures) [11], [12].…”

Section: Introductionmentioning

confidence: 99%

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Quality of Care of Hospitalized Internal Medicine Patients Bedspaced to Non-Internal Medicine Inpatient Units

et al. 2014

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BackgroundWhen the number of patients requiring hospital admission exceeds the number of available department-allotted beds, patients are often placed on a different specialty's inpatient ward, a practice known as “bedspacing”. Whether bedspacing affects quality of patient care has not been previously studied.MethodsWe reviewed consecutive general internal medicine (GIM) admissions for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and pneumonia at St. Michael's Hospital in Toronto, Canada, from 2007 to 2011 and examined whether quality of care differs between bedspaced and nonbedspaced patients. We matched each bedspaced patient with a GIM ward patient admitted on the same call shift with the same diagnosis. The primary outcome was the ratio of the actual to the estimated length of stay (ELOS). General and disease specific measures for CHF, COPD, and pneumonia (e.g. fluid restriction) were evaluated, as well as 30-day Emergency Department (ED) and hospital readmissions.ResultsOverall, 1639 consecutive admissions were reviewed, and 39 matched pairs for CHF, COPD and pneumonia were studied. Differences in both general and disease specific care measures were not detected between groups. For many disease-specific comparisons, ordering and adherence to quality of care indicators was low in both groups.ConclusionsWe were unable to detect differences in quality of care between bedspaced and nonbedspaced patients. As high patient volumes and hospital overcrowding remains, bedspacing will likely continue. More research is required in order to determine if quality of care is compromised by this ongoing practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quality of Care of Hospitalized Internal Medicine Patients Bedspaced to Non-Internal Medicine Inpatient Units

et al. 2014

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“…6 Some studies have demonstrated an association between length of emergency department boarding of patients and mortality, increased overall length of stay, 14 medication delays, and adverse events. 15,16 …”

Section: Discussionmentioning

confidence: 99%

The Impact of Methicillin-ResistantStaphylococcus aureus(MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations

Shenoy

Lee

Hou

et al. 2016

Infect. Control Hosp. Epidemiol.

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Objective To determine the impact of MRSA/VRE designations, or flags, on selected hospital operational outcomes. Design Retrospective cohort study of inpatients admitted to the Massachusetts General Hospital during 2010–2011. Methods Operational outcomes were time to bed arrival, acuity-unrelated within-hospital transfers, and length of stay. Demographic and clinical characteristics – including age, gender, severity of illness on admission, admit day of week, residence prior to admission, hospitalization within the prior 30 days, clinical service, and discharge destination – were used as covariates. Results A total of 81,288 admissions were included. After adjusting for covariates, patients with a MRSA/VRE flag at the time of admission experienced a mean delay in time to bed arrival of 1.03 (9.63 [95% CI 9.39–9.88] hours vs. 8.60 [95% CI 8.47–8.73] hours); had 1.19 times the odds [95% CI, 1.13–1.26] of experiencing an acuity-unrelated within-hospital transfer, and experienced a mean length of stay 1.76 days longer (7.03 [95% CI 6.82–7.24] days vs. 5.27 [95% CI 5.15–5.38] days) compared to patients with no MRSA/VRE flag. Conclusions MRSA/VRE designation was associated with delays in time to bed arrival, increased likelihood of acuity-unrelated within-hospital transfers, and extended length of stay. Efforts to identify patients who have cleared MRSA/VRE colonization are critically important to mitigate inefficient use of resources and improve inpatient flow.

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“…These findings are consistent with previous studies that found no association between hallway boarding and medication delays or adverse events. [14,18] We acknowledge that the eligibility criteria for inpatient hallway admission may introduce some selection bias. However, these criteria were developed and implemented institution-wide as temporary hallway beds did not have infrastructure capabilities to support isolation, telemetry or high flow oxygen.…”

Section: Discussionmentioning

confidence: 99%

The association between the transfer of emergency department admitted patients to inpatient hallways and outcomes of oncology patients

Lim

Cheung²,

Trudeau³

et al. 2015

JHA

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Objective: A protocol was implemented to ease Emergency Department (ED) crowding by moving suitable admitted patients into inpatient hallway beds (HALL) or off-service beds (OFF) when beds on an admitting service's designated ward (ON) were not available. This study assessed the impact of hallway and off-service oncology admissions on ED patient flow, quality of care and patient satisfaction. Methods: Retrospective and prospective data were collected on patients admitted to the medical oncology service from Jan 1 to Dec 31, 2011. Data on clinician assessments and time performance measures were collected. Satisfaction surveys were prospectively administered to all patients. Results: Two hundred and ninty-seven patients (117 HALL, 90 OFF, 90 ON) were included in this study. There were no significant differences between groups for frequency of physician assessments, physical exam maneuvers at initial physician visit, time to complete vital signs or time to medication administration. The median (IQR) time spent admitted in the ED prior to departure from the ED was significantly longer for HALL patients (5.53 hrs [1.59-13.03 hrs]) compared to OFF patients (2.00 hrs [0.37-3.69 hrs]) and ON patients (2.18 hrs [0.15-5.57 hrs]) (p < .01). Similarly, the median (IQR) total ED length of stay was significantly longer for HALL patients (13.82 hrs [7.43-20.72 hrs]) compared to OFF patients (7.18 hrs [5.72-11.42 hrs]) and ON patients (9.34 hrs [5.43-14.06 hrs]) (p < .01). HALL patients gave significantly lower overall satisfaction scores with mean (SD) satisfaction scores for HALL, OFF and ON patients being 3.58 (1.20), 4.23 (0.58) and 4.29 (0.69) respectively (p < .01). Among HALL patients, 58% were not comfortable being transferred into the hallway and 4% discharged themselves against medical advice. Conclusions: The protocol for transferring ED admitted patients to inpatient hallway beds did not reduce ED length of stay for oncology patients. The timeliness and frequency of clinical assessments were not compromised; however, patient satisfaction was decreased.

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An Empirical Assessment of Boarding and Quality of Care: Delays in Care Among Chest Pain, Pneumonia, and Cellulitis Patients

Abstract: Background: As hospital crowding has increased, more patients have ended up boarding in the emergency department (ED) awaiting their inpatient beds. To the best of our knowledge, no study has compared the quality of care of boarded and nonboarded patients.

Cited by 46 publications

References 44 publications

Quality of Care of Hospitalized Internal Medicine Patients Bedspaced to Non-Internal Medicine Inpatient Units

Quality of Care of Hospitalized Internal Medicine Patients Bedspaced to Non-Internal Medicine Inpatient Units

The Impact of Methicillin-ResistantStaphylococcus aureus(MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations

The association between the transfer of emergency department admitted patients to inpatient hallways and outcomes of oncology patients

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