Caring for Inpatient Boarders in the Emergency Department: Improving Safety and Patient and Staff Satisfaction

Bornemann-Shepherd, Melanie; Le-Lazar, Jamie T. T.; Makic, Mary Beth Flynn; DeVine, Deborah; McDevitt, Kelly; Paul, Marcee

doi:10.1016/j.jen.2014.04.012

Cited by 15 publications

(8 citation statements)

References 16 publications

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“…Patient boarding due to limited bed availability exposes patients from a specialty unit to care in a ward that may be unfamiliar and/or under‐resourced to deliver the specialised care required for the patient's individual needs. Again, this has been reported elsewhere and is closely linked with attempts to manage increasing admissions and demands (Bornemann‐Shepherd et al., 2015; Healy‐Rodriguez et al., 2014). The impact of boarding upon the care of the patient includes delayed investigations, prolonged length of stay, PAE and suboptimal communication with and about the patient (Puvaneswaralingam & Ross, 2016).…”

Section: Discussionsupporting

confidence: 58%

Practice priorities for acute care nursing: A Delphi study

Connell

Plummer

Endacott

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. Background Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. Design Delphi Method. Method A three‐round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. Results High patient acuity or complexity, as well as inadequate bed space on wards, are “very high” risks that occur “often” and “very often,” respectively. The pressure to admit patients, delayed medical review and patient boarding are all “high” risks that occur “often.” Though only occurring “sometimes,” inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a “very high” risk to patient care. Conclusion The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system‐wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. Relevance to clinical practice This study provides a description of the challenges that face acute care nursing in the provision of safe and high‐quality care.

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Section: Discussionsupporting

confidence: 58%

Practice priorities for acute care nursing: A Delphi study

Connell

Plummer

Endacott

et al. 2020

Journal of Clinical Nursing

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“…ED boarding reflects symptoms of a systemic healthcare problem with multiple downstream effects; it is not simply a failure of ED operations. ED-CCM boarding impacts nursing, respiratory therapy, pharmacy, radiology, and laboratory services, and it contributes to poor staff satisfaction ( 49 , 50 ). Understanding the effect on the care process, staff, and clinical outcomes of critically ill patients may promote collaboration between key clinical and institutional stakeholders to mitigate risk, identify relevant barriers, and explore solutions.…”

Section: Resultsmentioning

confidence: 99%

Boarding of Critically Ill Patients in the Emergency Department

Mohr

Wessman

Bassin

et al. 2020

Critical Care Medicine

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“…ED boarding reflects symptoms of a systemic healthcare problem with multiple downstream effects; it is not simply a failure of ED operations. ED‐CCM boarding impacts nursing, respiratory therapy, pharmacy, radiology, and laboratory services, and it contributes to poor staff satisfaction 49,50 . Understanding the effect on the care process, staff, and clinical outcomes of critically ill patients may promote collaboration between key clinical and institutional stakeholders to mitigate risk, identify relevant barriers, and explore solutions.…”

Section: Resultsmentioning

confidence: 99%

Boarding of critically Ill patients in the emergency department

et al. 2020

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Objectives Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill. The objective of this article is to review the U.S. literature on (1) the frequency of emergency department boarding among the critically ill, (2) the outcomes associated with critical care patient boarding, and (3) local strategies developed to mitigate the impact of emergency department critical care boarding on patient outcomes. Data sources and study selection Review article. Data extraction and data synthesis Emergency department–based boarding of the critically ill patient is common, but no nationally representative frequency estimates has been reported. Boarding literature is limited by variation in the definitions used for boarding and variation in the facilities studied (boarding ranges from 2% to 88% of ICU admissions). Prolonged boarding in the emergency department has been associated with longer duration of mechanical ventilation, longer ICU and hospital length of stay, and higher mortality. Health systems have developed multiple mitigation strategies to address emergency department boarding of critically ill patients, including emergency department‐based interventions, hospital‐based interventions, and emergency department–based resuscitation care units. Conclusions Emergency department boarding of critically ill patients was common and was associated with worse clinical outcomes. Health systems have generated a number of strategies to mitigate these effects. A definition for emergency department boarding is proposed. Future work should establish formal criteria for analysis and benchmarking of emergency department–based boarding overall, with subsequent efforts focused on developing and reporting innovative strategies that improve clinical outcomes of critically ill patients boarded in the emergency department.

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Caring for Inpatient Boarders in the Emergency Department: Improving Safety and Patient and Staff Satisfaction

Cited by 15 publications

References 16 publications

Practice priorities for acute care nursing: A Delphi study

Practice priorities for acute care nursing: A Delphi study

Boarding of Critically Ill Patients in the Emergency Department

Boarding of critically Ill patients in the emergency department

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