Emergency department boarding times for patients admitted to intensive care unit: Patient and organizational influences

摘要

Background: The phenomenon of emergency department (ED) boarding hinders hospitals efforts to optimize operational efficiencies and sustain quality care for critically ill patients. After a decision has been made to admit a patient to an intensive care unit (ICU), patients can be held or boarded in ED for a period of time prior to departure. These admitted critically ill patients continue to receive care in the ED, a situation that disrupts patient flow and contributes to system gridlock.;Purpose: The purpose of this study was to explore differences in the duration of ED-ICU boarding by various critically ill patient and organizational characteristics.;Design: The study used an exploratory descriptive design.;Sample: The sample was identified from electronic data sources detailing the ED boarding of adult patients directly admitted to the ICU in a northern Ontario hospital between April 1st and September 30th of 2011.;Data collection: Using a standardized measure, data was extracted from three data sources storing patient, emergency and hospital information.;Data analysis: Data analysis involved cursory descriptive methods to identify data patterns using a graphic method referred to as boxplots. This analytical process illustrated the distribution of ED-ICU boarding times relative to 16 independent variables.;Results: During the six month study period, 122 individuals were boarded in the ED prior to ICU arrival. The majority were males, ≥ 55 years old, arrived by ground ambulance on a weekday, and were admitted with trauma. Less variability in the distribution of boarding time for ED-ICU patients was statistically significant for three patient characteristics, these include; an elevated Canadian Emergency Department Triage and Acuity Scale (CTAS) scores, who were intubated, and received 3 or more diagnostic and treatment procedures while in the ED. The median boarding time was 34 minutes, with a range from 0 to 1549 minutes.;Conclusions: The study results provide a preliminary profile that may assist clinicians and administrators in understanding the complex interplay of variables contributing to ED-ICU boarding. The results also highlight the need for further exploration into the role of interdisciplinary and inter-departmental collaboration in expediting ED flow.