Emergency department boarding time and in-hospital mortality: A prospective observational study.

Abstract

Objectives: We aimed to study the association between prolonged boarding time in the emergency department (ED) and in-hospital mortality among patients triaged red at presentation.

Methods: It was a single-center prospective observational study conducted among 300 patients who presented to the ED of a tertiary care teaching institute in North India. The boarding time was calculated as the time interval between the time at which the patient was advised admission and the time at which the patient was admitted to the indoor bed. Risk stratification of patients was done based on National Early Warning Score 2 (NEWS2) at presentation. The patient was then followed up for the duration of their in-hospital course, till discharge or death.

Results: The mean boarding time was higher in patients who died, as compared to those who were alive, but the difference was not found to be statistically significant (14.13 h vs. 11.89 h, P = 0.053). Boarding time had a weak discriminatory power on receiver operating characteristic (ROC) analysis (area under the ROC: 0.59: 95% confidence interval [CI]: 0.51-0.67, P = 0.046). A boarding time of more than 9.98 h was found to be 70.8% specific and 43.6% sensitive for predicting in-hospital mortality. On logistic regression, an increase in boarding time was found to independently increase the odds of mortality, albeit weakly (adjusted odds ratio: 1.06; 95% CI: 1.00-1.12, P = 0.03). A NEWS2 score > 4 at presentation and a requirement of high-dependency unit (HDU)/ıntensive care unit (ICU) admission were found to be significant predictors of in-hospital mortality.

Conclusion: Prolonged ED boarding times may be weakly associated with in-hospital mortality. Patients with an increased NEWS2 score at presentation and those requiring HDU/ICU admissions were at higher risk of in-hospital mortality.