Is emergency department boarding associated with undesirable events?

Originally published in Journal Watch Emergency Medicine

by Richard D. Zane, MD, FAAEM

Nearly 30% of ED boarders at a single tertiary care hospital experienced undesirable events.

Emergency department boarding — inpatients in the ED awaiting a hospital bed assignment — is common across the U.S. Although boarding is inconvenient and demoralizing for both patients and providers, few studies have examined outcomes of boarding.

In this retrospective chart review of 151 ED-boarded patients who were admitted to a single tertiary care hospital in Boston during 3 days in 2003, the authors measured the frequency of undesirable events, which were defined as deviations from hospital-based standards (missed relevant ED treatment, home medications, or laboratory evaluations) and adverse events (ED death, aspiration, suboptimal blood pressure control, hypotension, hypoxia, arrhythmia, or others). Forty-two patients (28%) had at least one undesirable event. Of 50 undesirable events, 88% were deviations from hospital-based standards, mostly missed home medications (61%), and 12% were adverse events; no deaths or aspirations occurred. Age >50 and presence of multiple comorbidities were associated with increased frequency of undesirable events.

Comment: At the time of the study, this institution had no specific policies or procedures that outlined the care of boarder patients, and such patients were managed exclusively by emergency physicians. That practice seems aberrant compared with most institutions, where boarders are managed by inpatient services. Whether or not this institution’s approach has changed since 2003, the frequency of ED boarding has increased dramatically nationwide, and the 28% frequency of undesirable events is startling, no matter what the cause. ED boarding seems to be a constant condition for the immediate future, and we need to ensure that ED-boarded patients receive the same standard of care as any other inpatient should rightfully expect.


Liu SW et al. A pilot study examining undesirable events among emergency department–boarded patients awaiting inpatient beds. Ann Emerg Med 2009 Sep; 54:381.

Copyright © 2009. Massachusetts Medical Society. All rights reserved.

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