Boarding is Associated with Reduced Emergency Department Efficiency that is not Mitigated by a Provider in Triage

• Published in: The western journal of emergency medicine 2020-04, Vol.21 (3), p.647-652
• Main Authors: Napoli, Anthony M, Ali, Shihab, Lawrence, Alexis, Baird, Janette
• Format: Article
• Language: English
• Subjects: Efficiency; Emergency Department Operations
• ISSN: 1936-900X; 1936-9018; 1936-9018
• DOI: 10.5811/westjem.2020.2.45728

Boarding of patients in the emergency department (ED) is associated with decreased ED efficiency. The provider-in-triage (PIT) model has been shown to improve ED throughput, but it is unclear how these improvements are affected by boarding. We sought to assess the effects of boarding on ED throughput and whether implementation of a PIT model mitigated those effects. We performed a multi-site retrospective review of 955 days of ED operations data at a tertiary care academic ED (AED) and a high-volume community ED (CED) before and after implementation of PIT. Key outcome variables were door to provider time (D2P), total length of stay of discharged patients (LOSD), and boarding time (admit request to ED departure [A2D]). Implementation of PIT was associated with a decrease in median D2P by 22 minutes or 43% at the AED (p < 0.01), and 18 minutes (31%) at the CED (p < 0.01). LOSD also decreased by 19 minutes (5.9%) at the AED and 8 minutes (3.3%) at the CED (p