The Association Between Transfer of Emergency Department Boarders to Inpatient Hallways and Mortality: A 4-Year Experience
Presented at the ACEP Research Forum, October 2008, Chicago, IL.
Received 3 November 2008; received in revised form 26 January 2009 and 23 February 2009; accepted 3 March 2009. published online 06 April 2009.
Refers to article:
Advancing the Science of Emergency Department Crowding: Measurement and Solutions
, 03 July 2009
Jesse M. Pines, Donald M. Yealy
Annals of Emergency Medicine
October 2009 (Vol. 54, Issue 4, Pages 511-513) Full Text |
Full-Text PDF (111 KB)
Study objective
We developed and implemented an institutional protocol aimed at reducing crowding by admitting boarded patients to hospital inpatient hallways. We hypothesized that transfer of admitted patients from the emergency department (ED) to inpatient hallways would be feasible and not create patient harm.
Methods
This was a retrospective cohort study in a suburban, academic ED with an annual census of 70,000. We studied consecutive patients admitted from our ED between January 2004 and January 2008. In 2001, a multidisciplinary team developed and implemented an institutional protocol in which admitted adult patients boarded in the ED were transferred to hospital inpatient hallways under select conditions. We extracted data from the electronic medical record system, measuring patient demographics, ED disposition (discharge, admit to floor, admit to hallway), ED length of stay, and inhospital mortality. We report ED length of stay, subsequent transfer to an ICU, and hospital mortality of patients admitted to standard and hallway inpatient beds.
Results
Of 55,062 ED patients admitted, there were 1,798 deaths. Of all admissions, 2,042 (4%) went to a hallway; 53,020 went to a standard bed. Patients admitted to standard and hallway beds were similar in age (median [interquartile range] 55 years [37 to 72 years] and 54 years [41 to 70 years], respectively) and sex (48.2% and 50% female patients, respectively). The median (interquartile range) times from ED triage to actual admission in patients admitted to standard and hallway beds were 426 minutes (306 to 600 minutes) and 624 (439 to 895 minutes) minutes, respectively (P<.001). Median ED census at triage was lower for standard bed admissions than for hallway patients (44 [33 to 53] versus 50 [38 to 61], respectively, P<.001). Inhospital mortality rates were higher among patients admitted to standard beds (2.6%; 95% confidence interval [CI] 2.5% to 2.7%) than among patients admitted to hallway beds (1.1%; 95% CI 0.7% to 1.7%). ICU transfers were also higher in the standard bed admissions (6.7% [95% CI 6.5% to 6.9%] versus 2.5% [95% CI 1.9% to 3.3%]).
Conclusion
Transfer of ED-boarded admitted patients to an inpatient hallway occurs during high ED census and waiting times for admission but does not appears to result in patient harm.
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY
Address for correspondence: Adam J. Singer, MD, Stony Brook University, HSC Level 4, Rm 080, Stony Brook, NY 11794-8350; 631-444-7857
Supervising editors: Debra E. Houry, MD, MPH; Donald M. Yealy, MD
Author contributions: AV conceived the study, and obtained research funding. AV, AJS, and HCT supervised data collection and analysis. HCT provided statistical advice on study design and analyzed the data. AJS drafted the article, and all authors contributed substantially to its revision. AV takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Funded in part by a research grant from the Emergency Medicine Foundation.
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