Inpatient boarding in the emergency departments and clinical outcomes: A propensity-matched study

Objectives

The study evaluated clinical outcomes in patients who experienced inpatient boarding in the ED (boarders) compared to those admitted directly (non-boarders).

Methods

Retrospective propensity-matched study of consecutive adults presented to 22 emergency departments and were subsequently admitted to 17 hospitals across Southeast Minnesota. The exposure variable was ED boarding. ED boarding was defined as patients flagged by ED physicians for admission and awaiting an inpatient bed, regardless of the time to flagging. The primary outcomes were length of hospital stay (LOS) and in-hospital mortality. The secondary outcome was all-cause mortality within 90 days after hospitalization. Boarders were matched to non-boarders using 86 covariates. Poisson, logistic, and Cox regression models were used to assess associations, with subgroup analyses by age, sex, and ED location.

Results

From April 1, 2019, to March 30, 2024, 821,244 ED visits and 151,834 (26.9 %) admissions. Of these, 3173 (1.9 %) were boarders (median time: 4.2 h; IQR, 1.8–9.7). Boarding was not associated with in-hospital mortality (OR, 0.84; 95 % CI, 0.59–1.20; P = 0.340) or LOS (IRR, 1.02; 95 % CI, 0.99–1.04; P = 0.088), but was associated with higher 90-day mortality (HR, 1.30; 95 % CI, 1.15–1.46; P = 0.005). These findings were consistent across age, sex, and ED location.

Conclusions

In this multicenter, propensity score–matched study, ED boarding was not associated with LOS or in-hospital mortality but was associated with a 1.3-fold increase in 90-day mortality, consistent across age, sex, and ED location.