The Association Between Transfer of Emergency Department Boarders to Inpatient Hallways and Mortality: A 4-Year Experience

Viccellio, Asa; Santora, Carolyn; Singer, Adam J.; Thode, Henry C.; Henry, Mark C.

doi:10.1016/j.annemergmed.2009.03.005

Cited by 120 publications

(101 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[20][21][22][23][24] Several strategies to reduce ED crowding have been cited in the literature, including co-ordinated hospital bed management systems, timing elective admissions to smooth hospital census, temporary inpatient admission and discharge units, hospital full capacity protocols, financial incentives, boarding admitted patients in inpatient hallways when the ED is beyond capacity, and multidisciplinary hospital flow management teams. 22,23,25,26 The results of this investigation suggest that it would be prudent for leaders responsible for the care of acute stroke patients to join ED providers in their ongoing call for large-scale, systemic improvements shown to reduce ED overcrowding.…”

Section: Strokementioning

confidence: 99%

Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding

Reznek

Murray

Youngren

et al. 2017

Stroke

View full text Add to dashboard Cite

Background and Purpose-National guidelines call for door-to-imaging time (DIT) within 25 minutes for suspected acute stroke patients. Studies examining factors that affect DIT have focused primarily on stroke-specific care processes and patient-specific factors. We hypothesized that emergency department (ED) crowding is associated with longer DIT. Methods-We conducted a retrospective investigation of 1 year of consecutive patients in our prospective Code Stroke registry, which included all ED stroke team activations. The registry and electronic health records were abstracted for 27 potential predictors of DIT, including patient, stroke care process, and ED operational factors. We fit a multivariate logistic regression model and calculated odds ratios and 95% confidence intervals. Second, we constructed a random forest recursive partitioning model to cross-validate our findings and explore the proportional importance of each category of predictor. Our primary outcome was the binary variable of DIT within the 25-minute goal. Results-A total of 463 patients met inclusion criteria. In the regression model, ED occupancy rate emerged as a predictor of DIT, with odds ratio of 0.83 (95% confidence interval, 0.75-0.91) of DIT within 25 minutes per 10% absolute increase in ED occupancy rate. The secondary analysis estimated that ED operational factors accounted for nearly 14% of the algorithm's prediction of DIT. Conclusions-ED crowding is associated with reduced odds of meeting DIT goals for acute stroke. In addition to improving stroke-specific processes of care, efforts to reduce ED overcrowding should be considered central to optimizing the timeliness of acute stroke care.

show abstract

Section: Strokementioning

confidence: 99%

Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding

Reznek

Murray

Youngren

et al. 2017

Stroke

View full text Add to dashboard Cite

show abstract

“…However, a focused approach to solve hallway crowding has been adapted by leading hospitals [62,63]. Emergency and inpatient physicians at the Stony Brook University Hospital in New York collaborated and developed a program whereby admitted hallway patients are transferred out of the ED to inpatient hallways [64]. Patients receive more attention in a quieter and more private environment.…”

Section: Solutions To Hallway Carementioning

confidence: 99%

Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths

Richards

Linden

Derlet

2014

Advances in Emergency Medicine

View full text Add to dashboard Cite

Emergency departments (ED) worldwide have experienced dramatic increases in crowding over the past 20 years that now have reached critical levels. One consequence of ED crowding has been the routine use of ED hallways for patient care. This includes ED patients who are awaiting care but are considered unstable to remain in the waiting room, patients who are undergoing active medical and trauma treatment, and patients who have been stabilized but await transfer to an inpatient bed (boarding) or another institution. Compared with licensed hospital or standard ED beds, care in ED hallways results in increased patient morbidity and mortality, as well as patient and staff dissatisfaction. Complications experienced by hallway patients include unrecognized sudden respiratory arrest or unstable cardiac arrhythmias, delay in time-sensitive procedures and laboratory testing, delay in receiving important medications, excessive or unrelieved pain, overall increased length of stay, increased disability, and exposure to traumatic psychological events. While much has been published on the general problems of ED crowding, only recently have studies focused exclusively on the issues of providing care in ED hallways. This review summarizes the current issues, challenges, and solutions for hallway care.

show abstract

“…Patients psychologically prefer to be admitted to the ward's hallways than staying in the ED without any specific treatment or workup. It was also shown that admitting patients to the wards' hallways does not cause any harm to those admitted patients [17].…”

Section: Discussionmentioning

confidence: 99%

From an Overcrowded to a Smoothly Functioning Emergency Department within Two Months

Basis¹

2017

J Gen Pract

View full text Add to dashboard Cite

Background: Our Emergency Department (ED) went through two periods with different managers. Although the number of beds, visits and admissions during these two periods didn't change significantly, a change in the ED's policy, without a change in the hospital's policy, converted a very crowded ED to an uncrowded one within few weeks, and changed the pattern of work in the hospital, gradually for many years.

show abstract

The Association Between Transfer of Emergency Department Boarders to Inpatient Hallways and Mortality: A 4-Year Experience

Cited by 120 publications

References 28 publications

Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding

Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding

Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths

From an Overcrowded to a Smoothly Functioning Emergency Department within Two Months

Contact Info

Product

Resources

About