Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service

被引:15
作者
Lord, Kito [1 ]
Parwani, Vivek [1 ]
Ulrich, Andrew [1 ]
Finn, Emily B. [2 ]
Rothenberg, Craig [1 ]
Emerson, Beth [2 ,3 ]
Rosenberg, Alana [2 ]
Venkatesh, Arjun K. [1 ,4 ]
机构
[1] Yale Univ, Sch Med, Dept Emergency Med, New Haven, CT USA
[2] Yale Univ, Ctr Healthcare Innovat Redesign & Learning, New Haven, CT USA
[3] Yale Univ, Sch Med, Dept Pediat, Sect Pediat Emergency Med, New Haven, CT 06510 USA
[4] Yale Univ, Sch Med, Ctr Outcomes Res & Evaluat, New Haven, CT USA
基金
美国国家卫生研究院; 美国医疗保健研究与质量局;
关键词
Emergency department; Boarding; Overcrowding; CARE;
D O I
10.1016/j.ajem.2018.03.043
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. Method: We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015. This study was conducted in an urban, academic hospital with an annual adult ED census over 90,000. We defined boarding as patients with greater than 4 h from ED bed order to ED departure to hospital ward. The primary outcome was a composite of adverse outcomes in the first 24 h of admission, including RRT activation, care escalation to intensive care, or in-hospital mortality. Results: A total of 31,426 patient encounters were included of which 3978 (12.7%) boarded in the ED for 4 h or more. Adverse outcomes occurred in 1.92% of all encounters. Comparing boarded vs. non-boarded patients, 41 (1.03%) vs. 244 (0.90%) patients experienced a RRT activation, 53 (1.33%) vs. 387 (1.42%) experienced a care escalation, and 1 (0.03%) vs. 12 (0.04%) experienced unanticipated in-hospital death, within 24 h of ED admission. In unadjusted analysis, there was no difference in the composite outcome between boarding and non-boarding patients (1.91% vs. 1.91%, p = 0.994). Regression analysis adjusted for patient demographics, acuity, and comorbidities also showed no association between boarding and the primary outcome. A sensitivity analysis showed an association between ED boarding and the composite outcome inclusive of the entire inpatient hospital stay (5.8% vs. 4.7%, p = 0.003). Conclusion: Within the first 24 h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding. (C) 2018 Elsevier Inc. All rights reserved.
引用
收藏
页码:1246 / 1248
页数:3
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