The impact of COVID-19 on emergency department boarding and in-hospital mortality

Griffin, Gregory; Krizo, Jessica; Mangira, Caroline; Simon, Erin L.

doi:10.1016/j.ajem.2023.01.049

Cited by 14 publications

(5 citation statements)

References 14 publications

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“…The first time period, December 2021 through January 2022, corresponded to high-capacity hospitals and boarding hours over 800 h per day during the winter COVID wave of 2021–2022 ( Figure 3 ). 24 , 25 The second, August 2022 through October 2022, corresponded to an increase in boarding over 800 h per day due to the triple pandemic of influenza virus, respiratory syncytial virus, and COVID-19. An ED with 800 h per day of boarding is the equivalent of having 33.3 beds filled with inpatients for 24 h, or, assuming a 1:5 nurse to patient ratios, 800 h per day of boarding is the equivalent of six to seven nurses dedicated to taking care of boarding inpatients per shift.…”

Section: Resultsmentioning

confidence: 99%

Implementation of geriatric screening in the emergency department using the Consolidated Framework for Implementation Research

Southerland,

Gulker,

Van Fossen

et al. 2023

Academic Emergency Medicine

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ObjectiveImplementation of evidence‐based care processes (EBP) into the emergency department (ED) is challenging and there are only a few studies of real‐world use of theory‐based implementation frameworks. We report final implementation results and sustainability of an EBP geriatric screening program in the ED using the Consolidated Framework for Implementation Research (CFIR).MethodsThe EBP involved nurses screening older patients for delirium (Delirium Triage Screen), fall risk (4‐Stage Balance Test), and vulnerability (Identification of Seniors at Risk score) with subsequent appropriate referrals to physicians, therapy specialists, or social workers. The proportions of screened adults ≥65 years old were tracked monthly. Outcomes are reported January 2021–December 2022. Barriers encountered were classified according to CFIR. Implementation strategies were classified according to the CFIR‐Expert Recommendations for Implementing Change (ERIC).ResultsImplementation strategies increased geriatric screening from 5% to 68%. This did not meet our prespecified goal of 80%. Change was sustained through several COVID‐19 waves. Inner setting barriers included culture and implementation climate. Initially, the ED was treated as a single inner setting, but we found different cultures and uptake between ED units, including night versus day shifts. Characteristics of individuals barriers included high levels of staff turnover in both clinical and administrative roles and very low self‐efficacy from stress and staff turnover. Initial attempts with individualized audit and feedback were not successful in improving self‐efficacy and may have caused moral injury. Adjusting feedback to a team/unit level approach with unitwide stretch goals worked better. Identifying early adopters and conducting on‐shift education increased uptake. Lessons learned regarding ED culture, implementation in interconnected health systems, and rapid cycle process improvement are reported.ConclusionsThe pandemic exacerbated barriers to implementation in the ED. Cognizance of a large ED as a sum of smaller units and using the CFIR model resulted in improvements.

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Section: Resultsmentioning

confidence: 99%

Implementation of geriatric screening in the emergency department using the Consolidated Framework for Implementation Research

Southerland,

Gulker,

Van Fossen

et al. 2023

Academic Emergency Medicine

View full text Add to dashboard Cite

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“…During the early phases of the pandemic, changes in ED-to-ICU admissions and mortality rates were reported in several countries; the magnitude and direction of these changes varied regionally. For instance, ED-to-ICU admissions increased in the US [ 31 ] but decreased in Canada [ 32 ]. ICU mortality rates during the pandemic also manifested regional differences [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the early phase of the COVID-19 pandemic on emergency department-to-intensive care unit admissions in Korea: an interrupted time-series analysis

Lee,

Han,

Min

et al. 2024

BMC Emerg Med

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Background The coronavirus disease 2019 (COVID-19) pandemic resulted in significant disruptions to critical care systems globally. However, research on the impact of the COVID-19 pandemic on intensive care unit (ICU) admissions via the emergency department (ED) is limited. Therefore, this study evaluated the changes in the number of ED-to-ICU admissions and clinical outcomes in the periods before and during the pandemic. Methods We identified all adult patients admitted to the ICU through level 1 or 2 EDs in Korea between February 2018 and January 2021. February 2020 was considered the onset point of the COVID-19 pandemic. The monthly changes in the number of ED-to-ICU admissions and the in-hospital mortality rates before and during the COVID-19 pandemic were evaluated using interrupted time-series analysis. Results Among the 555,793 adult ED-to-ICU admissions, the number of ED-to-ICU admissions during the pandemic decreased compared to that before the pandemic (step change, 0.916; 95% confidence interval [CI] 0.869–0.966], although the trend did not attain statistical significance (slope change, 0.997; 95% CI 0.991–1.003). The proportion of patients who arrived by emergency medical services, those transferred from other hospitals, and those with injuries declined significantly among the number of ED-to-ICU admissions during the pandemic. The proportion of in-hospital deaths significantly increased during the pandemic (step change, 1.054; 95% CI 1.003–1.108); however, the trend did not attain statistical significance (slope change, 1.001; 95% CI 0.996–1.007). Mortality rates in patients with an ED length of stay of ≥ 6 h until admission to the ICU rose abruptly following the onset of the pandemic (step change, 1.169; 95% CI 1.021–1.339). Conclusions The COVID-19 pandemic significantly affected ED-to-ICU admission and in-hospital mortality rates in Korea. This study’s findings have important implications for healthcare providers and policymakers planning the management of future outbreaks of infectious diseases. Strategies are needed to address the challenges posed by pandemics and improve the outcomes in critically ill patients.

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“…We used a convenience sample of ED ICU boarders during the COVID‐19 pandemic that included periods of low (April 1 to May 31) and high (August 1 to September 30) boarding volume that reflected internal and national trends. 4 , 23 , 24 These periods differ in the total number of medical ICU admissions at our institution, ED length of stay, and the volume of medical ICU boarders.…”

Section: Methodsmentioning

confidence: 99%

Standardized evaluation of hand‐off documentation of ICU boarders in the emergency department

Kolikof,

Shaw,

Stenson

et al. 2023

JACEP Open

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ObjectiveThe boarding of ICU patients in the emergency department (ED) represents a considerable risk to patient safety. This study aims to describe the generation of a rubric to ensure the fidelity of vital, written hand‐off between ED teams.MethodsWe performed a mixed methods design to develop a scoring rubric to evaluate written hand‐off communication of medical ICU boarders between ED teams during the COVID‐19 pandemic. The primary outcome was the quality of the written hand‐off as agreed upon by the inter‐user agreement. Our secondary outcome included variability in written quality as a function of the number of separate and distinct ED teams at the point of the transition of care.ResultsThere was a moderate inter‐user agreement with rubric scoring (κ = 0.70 [95% confidence interval, 0.66–0.75]). The overall trend noted that several key elements, including code status, performed interventions, and contingency planning, were infrequently documented.ConclusionsWe effectively created a quality assurance tool for ED ICU boarders that ensures relevant and vital information is relayed between ED teams. Our analysis demonstrated that all relevant information is only sometimes present in the hand‐off.

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The impact of COVID-19 on emergency department boarding and in-hospital mortality

Cited by 14 publications

References 14 publications

Implementation of geriatric screening in the emergency department using the Consolidated Framework for Implementation Research

Implementation of geriatric screening in the emergency department using the Consolidated Framework for Implementation Research

Impact of the early phase of the COVID-19 pandemic on emergency department-to-intensive care unit admissions in Korea: an interrupted time-series analysis

Standardized evaluation of hand‐off documentation of ICU boarders in the emergency department

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