Association between boarding in the emergency department and in-hospital mortality: A systematic review

Boudi, Zoubir; Lauque, D.; Alsabri, Mohamed; Östlundh, Linda; Oneyji, Churchill; Khalemsky, Anna; Rial, Carlos Lojo; Liu, Shan W.; Camargo, Carlos A.; Aburawi, Elhadi H.; Möeckel, Martin; Slagman, Anna; Christ, Michael; Singer, Adam J.; Tazarourte, Karim; Rathlev, Niels K.; Grossman, Shamai A.; Bellou, Abdelouahab

doi:10.1371/journal.pone.0231253

Cited by 71 publications

(58 citation statements)

References 55 publications

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“…Previous investigations have addressed the question of whether ED crowding affects the mortality and morbidity rates in the ED. Moreover, several studies and systematic reviews have confirmed the association between ED crowding and increased mortality rates [9][10][11][12][13][14][15][16]. However, the effects of crowding on the quality of care were not examined in this study.…”

Section: Possible Crowding Responsesmentioning

confidence: 82%

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How the coronavirus disease 2019 pandemic changed the patterns of healthcare utilization by geriatric patients and the crowding: a call to action for effective solutions to the access block

et al. 2021

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The geriatric population constitutes a large slice of the population of Western countries and a class of fragile patients, with greater deaths due to COVID-19. The patterns of healthcare utilization change during pandemic disease outbreaks. Identifying the patterns of changes of this particular fragile subpopulation is important for future preparedness and response. Overcrowding in the emergency department (ED) can occur because of the volume of patients waiting to be seen, delays in patient assessment or treatment in the ED, or impediments to leaving the ED once the treatment has been completed. Overcrowding has become a serious and growing issue globally, which represents a serious impediment to healthcare utilization. To estimate the rate of ED visits attributable to the outbreak and guide the planning of strategies for managing ED access or after the outbreak of transmittable respiratory diseases. This observational study was based on a retrospective review of the epidemiological and clinical records of patients aged > 75 years who visited the Foundation IRCCS Policlinic San Matteo during the first wave of COVID-19 outbreak (February 21 to May 1, 2020; pandemic group). The analysis methods included estimation of the changes in the epidemiological and clinical data from the annual baseline data after the start of the COVID-19 pandemic. Outcome measures and analysis: Primary objective is the evaluation of ED admission rate change and ED overcrowding. Secondary objectives are the evaluation of modes of ED access by reason and triage code, access types, clinical outcomes (such as admission and mortality rates). During the pandemic, ED crowding increased dramatically, although the overall number of patients decreased, in the face of a percentage increase in those with high-acuity conditions, because of changes in patient management that have prolonged length of stay (LOS) and increased rates of access block. Overcrowding during the COVID-19 pandemic can be attributed to the Access Block. Access Block solutions are hence required to prevent a recurrence of crowding to any new viral wave or new epidemic in the future.

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Section: Possible Crowding Responsesmentioning

confidence: 82%

“…Elderly patients are at a higher risk than younger patients for complications related to hospitalization and long stays in the ED. Several international studies have reported that overcrowding can result in a greater number of adverse events, with increased morbidity and mortality, prolonged LOS, and reduced healthcare quality [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

How the coronavirus disease 2019 pandemic changed the patterns of healthcare utilization by geriatric patients and the crowding: a call to action for effective solutions to the access block

et al. 2021

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“…Overcrowding can lead to poor adherence to approved guidelines [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Overcrowding can also lead to patients’ poor outcomes, adverse events, increased morbidity and mortality, and overall inferior health care [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ]. Often, crowding is due to access block, which has been defined as a delay in bringing admitted patients to the inpatient beds at the wards [ 52 , 71 , 72 , 73 , 74 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of ED Organization with a Holding Area and a Dedicated Team on the Adherence to International Guidelines for Patients with Acute Pulmonary Embolism: Experience of an Emergency Department Organized in Areas of Intensity of Care

et al. 2020

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Background and Objectives: Adherence to guidelines by physicians of an emergency department (ED) depends on many factors: guideline and environmental factors; patient and practitioner characteristics; the social-political context. We focused on the impact of the environmental influence and of the patients’ characteristics on adherence to the guidelines. It is our intention to demonstrate how environmental factors such as ED organization more affect adherence to guidelines than the patient’s clinical presentation, even in a clinically insidious disease such as pulmonary embolism (PE). Materials and Methods: A single-center observational study was carried out on all patients who were seen at our Department of Emergency and Acceptance from 1 January to 31 December 2017 for PE. For the assessment of adherence to guidelines, we used the European guidelines 2014 and analyzed adherence to the correct use of clinical decision rule (CDR as Wells, Geneva, and YEARS); the correct initiation of heparin therapy; and the management of patients at high risk for short-term mortality. The primary endpoint of our study was to determine whether adherence to the guidelines as a whole depends on patients’ management in a holding area. The secondary objective was to determine whether adherence to the guidelines depended on patient characteristics such as the presence of typical symptoms or severe clinical features (massive pulmonary embolism; organ damage). Results: There were significant differences between patients who passed through OBI and those who did not, in terms of both administration of heparin therapy alone (p = 0.007) and the composite endpoints of heparin therapy initiation and observation/monitoring (p = 0.004), as indicated by the guidelines. For the subgroups of patients with massive PE, organ damage, and typical symptoms, there was no greater adherence to the decision making, administration of heparin therapy alone, and the endpoints of heparin therapy initiation and guideline-based observation/monitoring. Conclusion: Patients managed in an ED holding area were managed more in accordance with the guidelines than those who were managed only in the visiting ED rooms and directly hospitalized from there.

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“…A recent meta-analysis exploring ED boarding and in-hospital mortality revealed a weak trend toward this association driven by positive associations in half of the included studies. 13 None of the included studies demonstrated the reverse. The implications for the care of the ED patient are that timeliness, or lack thereof, can lead to measurable gains or losses in mortality.…”

Section: Discussionmentioning

confidence: 95%

“…In our study, we identified a longer length of stay for admitted patients, likely accounted for by an increased time of ED boarding. A recent meta‐analysis exploring ED boarding and in‐hospital mortality revealed a weak trend toward this association driven by positive associations in half of the included studies 13 . None of the included studies demonstrated the reverse.…”

Section: Discussionmentioning

confidence: 98%

Estimates of throughput and utilization at freestanding compared to low‐volume hospital‐based emergency departments

et al. 2020

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Association between boarding in the emergency department and in-hospital mortality: A systematic review

Cited by 71 publications

References 55 publications

How the coronavirus disease 2019 pandemic changed the patterns of healthcare utilization by geriatric patients and the crowding: a call to action for effective solutions to the access block

How the coronavirus disease 2019 pandemic changed the patterns of healthcare utilization by geriatric patients and the crowding: a call to action for effective solutions to the access block

Impact of ED Organization with a Holding Area and a Dedicated Team on the Adherence to International Guidelines for Patients with Acute Pulmonary Embolism: Experience of an Emergency Department Organized in Areas of Intensity of Care

Estimates of throughput and utilization at freestanding compared to low‐volume hospital‐based emergency departments

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