Sub-study: Emergency Department Boarding and Adverse Hospitalization Events

In 2006 the Institute of Medicine described emergency department (ED) overcrowding as a national crisis. Over the past decade, this overcrowding has worsened as the ED increasingly becomes the default site for unscheduled acute care and the primary entry point for hospital admissions.

ED overcrowding has been linked to a number of poor outcomes, including delays in pain management, delays in treatment for myocardial infarction and pneumonia, and increased rates of patients who leave the hospital without being seen by a clinician. Many hospitals track rapid deterioration of clinical status following admission from the ED, and a recent study demonstrated an association with increased mortality for ICU patients who were boarded in the ED for more than six hours. Little remains known about the relationship between ED overcrowding and escalations in care.

We will examine the relationship between ED boarding and adverse hospitalization events, including death, rapid response team activation, and escalations in care, among patients admitted from the ED to the hospital general medicine service. Data analysis will be completed through logistical regression and graphical representation of time thresholds.