Abstract
ABSTRACTBackgroundAccess block due to a lack of hospital beds causes emergency department (ED) crowding. We initiated the “boarding restriction protocol” that limits ED length of stay (LOS) for patients awaiting hospitalization to 24 hours from arrival. This study aimed to determine the effect of the protocol on ED crowding.MethodThis was a pre-post comparative study to compare ED crowding before and after protocol implementation. The primary outcome was the red stage fraction with more than 71 occupying patients in the ED (severe crowding level). LOS in the ED, treatment time and boarding time were compared. Additionally, the pattern of boarding patients staying in the ED according to the day of the week was confirmed.ResultsAnalysis of the number of occupying patients in the ED, measured at 10-minute intervals, indicated a decrease from 65.0 (51.0–79.0) to 55.0 (43.0–65.0) in the pre- and post-periods, respectively (p<0.0001). The red stage fraction decreased from 38.9% to 15.1% of the pre- and post-periods, respectively (p<0.0001). The proportion beyond the goal of this protocol of 24 hours decreased from 7.6% to 4.0% (p<0.0001). The ED LOS of all patients was similar: 238.2 (134.0–465.2) and 238.3 (136.9–451.2) minutes in the pre- and post-periods, respectively. In admitted patients, ED LOS decreased from 770.7 (421.4–1587.1) to 630.2 (398.0–1156.8) minutes (p<0.0001); treatment time increased from 319.6 (198.5–482.8) to 344.7 (213.4–519.5) minutes (p<0.0001); and boarding time decreased from 298.9 (109.5–1149.0) to 204.1 (98.7–545.7) minutes (p<0.0001). In the pre-period, boarding patients accumulated in the ED on weekdays, with the accumulation resolved on Fridays; this pattern was alleviated in the post-period.ConclusionsThe protocol effectively resolved excessive ED crowding by alleviating the accumulation of boarding patients in the ED on weekdays. Additional studies should be conducted on changes this protocol brings to patient flow hospital-wide.
Publisher
Cold Spring Harbor Laboratory