Patients Boarded in ED Risk Undesirable Events
Washington, DC-- More than one-quarter of patients who are held (or "boarded") in the emergency department after admission to the hospital suffer undesirable events, with older patients and those with chronic illnesses suffering the most. The study appears online today in the Annals of Emergency Medicine ("A Pilot Study Examining Undesirable Events Among Emergency Department Boarded Patients Awaiting Inpatient Beds").
"The emergency department is more focused on stabilizing and diagnosing patients and may be less well-equipped than inpatient units to provide an inpatient level of care to boarders," said study author Shan Liu MD, MPH, of Harvard Medical School in Boston, Mass. "Our study shows that a substantial number of patients experience an undesirable event while boarding, especially among patients older than 50 or those with multiple health problems."
Researchers examined the charts for 151 patients admitted to the hospital but held in the emergency department on three randomly selected days in 2003. Of those patients, 27.8 percent suffered from undesirable events. Of those experiencing undesirable events, the vast majority (88 percent) were over the age of 50. Nearly half (42 percent) of those with undesirable events were boarded for six hours or longer. Some of the undesirable events included missing necessary treatments, such as antibiotics, or missing medications normally taken at home.
"As emergency department crowding increases, emergency physicians are usually distracted by the flow of new patients, often providing insufficient attention to boarded patients," said Dr. Liu. "Hospitals must implement policies to manage these patients appropriately in order to provide optimal patient care. These policies may include moving patients up to the floor as quickly as possible, creating holding orders for boarders, or transferring care to the inpatient teams while patients board."
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society with nearly 27,000 members. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.