Is "boarding" appropriate to help reduce crowding in emergency departments?

Boyle, Adrian; Viccellio, Peter; Whale, Chris

doi:10.1136/bmj.h2249

Cited by 13 publications

(7 citation statements)

References 11 publications

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“…During surge conditions, critically ill patients are often admitted to another ICU within the same institution (e.g., surgical patients admitted to medical units), although this has not always improved outcomes ( 57 , 58 ). Some have proposed boarding ED patients on hospital wards ( 59 ). However, there is limited published data on this approach for critically ill patients.…”

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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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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show abstract

“…During surge conditions, critically ill patients are often admitted to another ICU within the same institution (e.g., surgical patients admitted to medical units), although this has not always improved outcomes 57,58 . Some have proposed boarding ED patients on hospital wards 59 . However, there is limited published data on this approach for critically ill patients.…”

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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“…Lastly, it is important to emphasize again that no changes were made with respect to healthcare professional staffing within the internal wards thus the policy change is associated with increased workload and greater burden of care. It should be assumed, that pushing the medical staff to cope with an increased workload is associated with accelerated burnout, which may have detrimental effects on the wellbeing of medical staff and the quality of medical service they deliver [ 2 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…As in other hospitals, SZMC’s ED starts to fill up from mid-morning, whereas inpatient beds in the internal wards often become available late in the afternoon or early in the evening [ 1 , 2 ]. SZMC adopted a protocol in which, every morning, ED staff, headed by a senior ED specialist, evaluates and assigns admitted patients to medical teams for further management and care.…”

Section: Introductionmentioning

confidence: 99%

The association between hallway boarding in internal wards, readmission and mortality rates: a comparative, retrospective analysis, following a policy change

Shoham

Munter

2021

Isr J Health Policy Res

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Background Emergency department overcrowding is associated with adverse clinical outcomes and poor patients and staff experience. Full capacity protocols enabling hallway boarding in internal wards are instituted to relieve emergency room overcrowding. The effect of hallway boarding on the clinical outcomes of all inpatients in the internal wards has not been studied. Early in 2016, a decision to enable hallway boarding in the internal wing in our medical center came into effect, comprising an abrupt change to the medical center’s policy. The objective of this study is to examine the effect of hallway boarding on patients who were hospitalized in the internal wards. Methods General linear regression analysis, based on administrative data about admissions of patients, from January 2013 through September 2019, is used to compare in-hospital mortality, 30-day readmission and 30-day mortality rates, of inpatients hospitalized in two internal departments in our medical center, before and after the policy change. Results Eight thousand five hundred eighty-three patients and 11,962 patients were admitted to internal departments A and B, before and after the policy change, respectively. Adjusted in-hospital mortality was lower after the policy change (OR 0.76, [CI, 0.65 to 0.90]), 30-day readmission was mildly higher (OR, 1.18 [CI, 1.00 to 1.40]) and no change in 30-day mortality was observed (OR 1.16 [CI, 0.88 to 1.53]). The results emanate from corresponding changes in department A. No apparent change was observed in the length of hospital stay in department A, while a shorter length of stay was observed in department B. Conclusion Enabling inpatient boarding in our medical center, effectively, had increased bed capacity and generated an increase in the volume of patients. It was associated with lower in-hospital mortality and an increased 30-day readmission, without increasing 30-day mortality. Since this is an observational study, conducted in a single center, further research is necessary to confirm and qualify these observations.

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Is "boarding" appropriate to help reduce crowding in emergency departments?

Cited by 13 publications

References 11 publications

Boarding of Critically Ill Patients in the Emergency Department

Boarding of Critically Ill Patients in the Emergency Department

Boarding of critically Ill patients in the emergency department

The association between hallway boarding in internal wards, readmission and mortality rates: a comparative, retrospective analysis, following a policy change

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