Boarding of critically Ill patients in the emergency department
Abstract Objectives Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its associat...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12107 |
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| author | Nicholas M. Mohr Brian T. Wessman Benjamin Bassin Marie‐Carmelle Elie‐Turenne Timothy Ellender Lillian L. Emlet Zachary Ginsberg Kyle Gunnerson Kevin M. Jones Bridgette Kram Evie Marcolini Susanna Rudy |
| author_facet | Nicholas M. Mohr Brian T. Wessman Benjamin Bassin Marie‐Carmelle Elie‐Turenne Timothy Ellender Lillian L. Emlet Zachary Ginsberg Kyle Gunnerson Kevin M. Jones Bridgette Kram Evie Marcolini Susanna Rudy |
| author_sort | Nicholas M. Mohr |
| collection | DOAJ |
| description | Abstract Objectives Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill. The objective of this article is to review the U.S. literature on (1) the frequency of emergency department boarding among the critically ill, (2) the outcomes associated with critical care patient boarding, and (3) local strategies developed to mitigate the impact of emergency department critical care boarding on patient outcomes. Data sources and study selection Review article. Data extraction and data synthesis Emergency department–based boarding of the critically ill patient is common, but no nationally representative frequency estimates has been reported. Boarding literature is limited by variation in the definitions used for boarding and variation in the facilities studied (boarding ranges from 2% to 88% of ICU admissions). Prolonged boarding in the emergency department has been associated with longer duration of mechanical ventilation, longer ICU and hospital length of stay, and higher mortality. Health systems have developed multiple mitigation strategies to address emergency department boarding of critically ill patients, including emergency department‐based interventions, hospital‐based interventions, and emergency department–based resuscitation care units. Conclusions Emergency department boarding of critically ill patients was common and was associated with worse clinical outcomes. Health systems have generated a number of strategies to mitigate these effects. A definition for emergency department boarding is proposed. Future work should establish formal criteria for analysis and benchmarking of emergency department–based boarding overall, with subsequent efforts focused on developing and reporting innovative strategies that improve clinical outcomes of critically ill patients boarded in the emergency department. |
| format | Article |
| id | doaj-art-fafea0064c014270b7d475c7234ca22f |
| institution | DOAJ |
| issn | 2688-1152 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-fafea0064c014270b7d475c7234ca22f2025-08-20T03:09:59ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522020-08-011442343110.1002/emp2.12107Boarding of critically Ill patients in the emergency departmentNicholas M. Mohr0Brian T. Wessman1Benjamin Bassin2Marie‐Carmelle Elie‐Turenne3Timothy Ellender4Lillian L. Emlet5Zachary Ginsberg6Kyle Gunnerson7Kevin M. Jones8Bridgette Kram9Evie Marcolini10Susanna Rudy11Department of Emergency Medicine and Department of Anesthesia University of Iowa Carver College of Medicine Iowa City IADepartment of Anesthesiology and Department of Emergency Medicine Washington University School of Medicine St. Louis MODepartment of Emergency Medicine Division of Critical Care University of Michigan Ann Arbor MIDepartment of Emergency Medicine and Department of Medicine Critical Care Medicine Palliative and Hospice Medicine University of Florida Gainesville FLDepartment of Emergency Medicine Indiana University School of Medicine Indianapolis INDepartment of Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh PAKettering Health System Department of Emergency & Critical Care Medicine Dayton OHDepartment of Emergency Medicine Division of Critical Care University of Michigan Ann Arbor MIProgram in Trauma R. Adams Cowley Shock Trauma Center, Department of Emergency Medicine University of Maryland School of Medicine Baltimore MADepartment of Pharmacy Duke University Hospital Durham NCSection of Emergency Medicine Department of Medicine Geisel School of Medicine at Dartmouth Hanover NHDepartment of Nursing Vanderbilt University Nashville TNAbstract Objectives Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill. The objective of this article is to review the U.S. literature on (1) the frequency of emergency department boarding among the critically ill, (2) the outcomes associated with critical care patient boarding, and (3) local strategies developed to mitigate the impact of emergency department critical care boarding on patient outcomes. Data sources and study selection Review article. Data extraction and data synthesis Emergency department–based boarding of the critically ill patient is common, but no nationally representative frequency estimates has been reported. Boarding literature is limited by variation in the definitions used for boarding and variation in the facilities studied (boarding ranges from 2% to 88% of ICU admissions). Prolonged boarding in the emergency department has been associated with longer duration of mechanical ventilation, longer ICU and hospital length of stay, and higher mortality. Health systems have developed multiple mitigation strategies to address emergency department boarding of critically ill patients, including emergency department‐based interventions, hospital‐based interventions, and emergency department–based resuscitation care units. Conclusions Emergency department boarding of critically ill patients was common and was associated with worse clinical outcomes. Health systems have generated a number of strategies to mitigate these effects. A definition for emergency department boarding is proposed. Future work should establish formal criteria for analysis and benchmarking of emergency department–based boarding overall, with subsequent efforts focused on developing and reporting innovative strategies that improve clinical outcomes of critically ill patients boarded in the emergency department.https://doi.org/10.1002/emp2.12107boardingcritical care outcomescritical careemergency department‐intensive care unitemergency service, hospitalresuscitation care units |
| spellingShingle | Nicholas M. Mohr Brian T. Wessman Benjamin Bassin Marie‐Carmelle Elie‐Turenne Timothy Ellender Lillian L. Emlet Zachary Ginsberg Kyle Gunnerson Kevin M. Jones Bridgette Kram Evie Marcolini Susanna Rudy Boarding of critically Ill patients in the emergency department Journal of the American College of Emergency Physicians Open boarding critical care outcomes critical care emergency department‐intensive care unit emergency service, hospital resuscitation care units |
| title | Boarding of critically Ill patients in the emergency department |
| title_full | Boarding of critically Ill patients in the emergency department |
| title_fullStr | Boarding of critically Ill patients in the emergency department |
| title_full_unstemmed | Boarding of critically Ill patients in the emergency department |
| title_short | Boarding of critically Ill patients in the emergency department |
| title_sort | boarding of critically ill patients in the emergency department |
| topic | boarding critical care outcomes critical care emergency department‐intensive care unit emergency service, hospital resuscitation care units |
| url | https://doi.org/10.1002/emp2.12107 |
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