Prolonged boarding in emergency department with neurologist coverage does not worse the outcomes for patients with acute ischemic stroke

Abstract

Shortage of hospital beds is a common phenomenon and some acute ischemic stroke patients have to be cared for in emergency department with their staffs. However, boarding acute stroke patients in emergency department for hospital ward beds has been associated with worse outcomes. Whether an additional coverage of neurologist for them would benefit was not elucidated. All acute ischemic stroke patients admitted to our hospital between January 2016 and December 2018 were retrospectively analyzed. Patients were classified according to the various emergency department length of stay. A binary Logistic regression was used to explore the relationship of coverage of neurologist for acute ischemic stroke patients admitted but boarded in emergency department to their hospital outcomes by adjusting for age, patient gender, comorbidities, triage urgency, initial National Institute of Health Stroke Scale (NIHSS) score, whether underwent thrombosis, admitted to Intensive care unit (ICU) and complications. A total of 1150 acute ischemic stroke patients were evaluated. 24.1% of them were admitted within 4 hours, 10.3% within 4–8 hours while 65.6% patients boarded in emergency department more than 8 hours although they were admitted, due to the shortage ward beds. However, with the neurologist coverage, their prolonged waiting hours in emergency department was not associated with poor patients’ outcomes including Modified Rankin Scale (mRS) ≥4 at discharge, long hospital length of stay and high hospital cost. In summary, with additional neurologist coverage for acute ischemic stroke patients who were admitted but boarded in emergency department, prolonged waiting hours in emergency department was not associated with worse patients’ outcomes including mRS ≥4 at discharge, long hospital length of stay and high hospital cost.