Boarding of Older Adults: A Concerning Trend in the Emergency Department

Abstract

Introduction Emergency department (ED) boarding (EDB) is the practice of holding admitted patients in the ED due to a lack of hospital beds. We identified one ED in our health system with a high rate of EDB. We sought to identify factors associated with EDB by comparing this ED to another ED with a similar patient profile. Methods We conducted a retrospective study comparing two similar EDs associated with 2 community hospitals in our healthcare system. Boarding was defined as a patient waiting ≥8 hours in ED for disposition. One ED located in a rural area within a 55-bed hospital was chosen as it was identified by the healthcare system as having a much higher percentage of boarders, particularly older adults. Another ED located in an urban setting within a 275-bed hospital was chosen for comparison due to a similarity in age demographics. Both EDs have geriatric ED accreditation. Deidentified, aggregate data was obtained. The acuity of patient illness was determined using the Emergency Severity Index (ESI) which is calculated on a scale of 1-5, with lower scores indicating a higher complexity. Results The total number of patients seen in the rural ED was 21,167; 33% were ≥65 years; 98% were white. In the urban ED, 23,814 patients were seen; 27% were ≥65 years; 96% were white. The rural ED had a slightly higher (lower complexity) mean acuity score (2.83) compared to the urban ED (2.62). Overall, the rural ED