Journal ArticleDOI
The association between length of emergency department boarding and mortality
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TLDR
Hospital mortality and hospital LOS are associated with length of ED boarding, and increases were still apparent after adjustment for comorbid conditions and other factors.Abstract:
Objectives: Emergency department (ED) boarding has been associated with several negative patient-oriented outcomes, from worse satisfaction to higher inpatient mortality rates. The current study evaluates the association between length of ED boarding and outcomes. The authors expected that prolonged ED boarding of admitted patients would be associated with higher mortality rates and longer hospital lengths of stay (LOS).
Methods: This was a retrospective cohort study set at a suburban academic ED with an annual ED census of 90,000 visits. Consecutive patients admitted to the hospital from the ED and discharged between October 2005 and September 2008 were included. An electronic medical record (EMR) system was used to extract patient demographics, ED disposition (discharge, admit to floor), ED and hospital LOS, and in-hospital mortality. Boarding was defined as ED LOS 2 hours or more after decision for admission. Descriptive statistics were used to evaluate the association between length of ED boarding and hospital LOS, subsequent transfer to an intensive care unit (ICU), and mortality controlling for comorbidities.
Results: There were 41,256 admissions from the ED. Mortality generally increased with increasing boarding time, from 2.5% in patients boarded less than 2 hours to 4.5% in patients boarding 12 hours or more (p < 0.001). Mean hospital LOS also showed an increase with boarding time (p < 0.001), from 5.6 days (SD ± 11.4 days) for those who stayed in the ED for less than 2 hours to 8.7 days (SD ± 16.3 days) for those who boarded for more than 24 hours. The increases were still apparent after adjustment for comorbid conditions and other factors.
Conclusions: Hospital mortality and hospital LOS are associated with length of ED boarding.
ACADEMIC EMERGENCY MEDICINE 2011; 18:1324–1329 © 2011 by the Society for Academic Emergency Medicineread more
Citations
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Emergency department crowding: A systematic review of causes, consequences and solutions
TL;DR: While the review identified increased presentations by the elderly with complex and chronic conditions as an emerging and widespread driver of crowding, more research is required to isolate the precise local factors leading to ED crowding.
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Effect of Emergency Department Crowding on Outcomes of Admitted Patients
Benjamin C. Sun,Renee Y. Hsia,Robert E. Weiss,David S. Zingmond,Li-Jung Liang,Weijuan Han,Heather McCreath,Steven M. Asch +7 more
TL;DR: periods of high ED crowding were associated with increased inpatient mortality and modest increases in length of stay and costs for admitted patients, and those days within the top quartile of diversion hours for a specific facility.
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Machine Learning-Based Prediction of Clinical Outcomes for Children During Emergency Department Triage.
TL;DR: In this prognostic study of a nationally representative sample of emergency department visits by children, machine learning–based triage models had better discrimination ability for clinical outcomes and disposition compared with the conventional triage approaches.
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Models and Insights for Hospital Inpatient Operations: Time-Dependent ED Boarding Time
TL;DR: The model predicts that implementing a hypothetical policy can eliminate excessive waiting for those patients who request beds in mornings, and is able to capture the inpatient flow dynamics at hourly resolution and can evaluate the impact of operational policies on both the daily and time-of-day waiting time performance.
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Team Scaffolds: How Meso-Level Structures Support Role-based Coordination in Temporary Groups
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References
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Journal ArticleDOI
Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions
Nathan R. Hoot,Dominik Aronsky +1 more
TL;DR: A structured overview of the literature may help to identify future directions for the crowding research agenda and provide valuable contributions toward better understanding and alleviating the daily crisis.
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The effect of emergency department crowding on clinically oriented outcomes
Steven L. Bernstein,Dominik Aronsky,Reena Duseja,Stephen K. Epstein,Dan Handel,Ula Hwang,Melissa L. McCarthy,K. John McConnell,Jesse M. Pines,Niels K. Rathlev,Robert W. Schafermeyer,Frank L. Zwemer,Michael J. Schull,Brent R. Asplin +13 more
TL;DR: A growing body of data suggests that ED crowding is associated both with objective clinical endpoints, such as mortality, as well as clinically important processes of care,such as time to treatment for patients with time-sensitive conditions such as pneumonia.
Journal ArticleDOI
Overcrowding in the nation's emergency departments: complex causes and disturbing effects.
TL;DR: In this article, a complex web of interrelated issues described in this article is used to show that ED overcrowding has multiple effects, including placing the patient at risk for poor outcome, prolonged pain and suffering of some patients, long patient waits, patient dissatisfaction, ambulance diversions in some cities, decreased physician productivity, increased frustration among medical staff, and violence.
Journal ArticleDOI
Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit.
Donald B. Chalfin,Stephen Trzeciak,Antonios Likourezos,Brigitte M. Baumann,R. Phillip Dellinger +4 more
TL;DR: Critically ill emergency department patients with a ≥6-hr delay inintensive care unit transfer had increased hospital length of stay and higher intensive care unit and hospital mortality, suggesting the need to identify factors associated with delayed transfer as well as specific determinants of adverse outcomes.