Effect of a Boarding Restriction Protocol on Emergency Department Crowding

다국어 초록 (Multilingual Abstract)

Purpose: Access block due to the lack of hospital beds causes crowding of emergency departments (ED). We initiated the “boardingrestriction protocol” that limits the time of stay in the ED for patients awaiting hospitalization to 24 hours from arrival. The purposeof this study was to determine the effect of the boarding restriction protocol on ED crowding.
Materials and Methods: The primary outcome was ED occupancy rate, which was calculated as the ratio of the number of occupyingpatients to the total number of ED beds. Time factors, such as length of stay (LOS), treatment time, and boarding time, wereinvestigated.
Results: The mean of the ED occupancy rate decreased from 1.532±0.432 prior to implementation of the protocol to 1.273±0.353after (p<0.001). According to time series analysis, the absolute effect caused by the protocol was -0.189 (-0.277 to -0.110) (p=0.001).
The proportion of patients with LOS exceeding 24 hours decreased from 7.6% to 4.0% (p<0.001). Among admitted patients, ED LOSdecreased from 770.7 (421.4–1587.1) minutes to 630.2 (398.0–1156.8) minutes (p<0.001); treatment time increased from 319.6(198.5–482.8) minutes to 344.7 (213.4–519.5) minutes (p<0.001); and boarding time decreased from 298.9 (109.5–1149.0) minutesto 204.1 (98.7–545.7) minutes (p<0.001). In pre-protocol period, boarding patients accumulated in the ED during the weekdays andresolved on Friday, but this pattern was alleviated in post-period.
Conclusion: The boarding restriction protocol was effective in alleviating ED crowding by reducing the accumulation of boardingpatients in the ED during the weekdays

참고문헌 (Reference)

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