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Effect of a Boarding Restriction Protocol on Emergency Department Crowding

Authors
 Ji Hwan Lee  ;  Ji Hoon Kim  ;  Incheol Park  ;  Hyun Sim Lee  ;  Joon Min Park  ;  Sung Phil Chung  ;  Hyeon Chang Kim  ;  Won Jeong Son  ;  Yun Ho Roh  ;  Min Joung Kim 
Citation
 YONSEI MEDICAL JOURNAL, Vol.63(5) : 470-479, 2022-05 
Journal Title
YONSEI MEDICAL JOURNAL
ISSN
 0513-5796 
Issue Date
2022-05
MeSH
Crowding* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Length of Stay ; Retrospective Studies ; Time Factors
Keywords
Emergency department ; crowding ; hospitalization ; quality of healthcare
Abstract
Purpose: Access block due to the lack of hospital beds causes crowding of emergency departments (ED). We initiated the "boarding restriction protocol" that limits the time of stay in the ED for patients awaiting hospitalization to 24 hours from arrival. The purpose of 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 occupying patients to the total number of ED beds. Time factors, such as length of stay (LOS), treatment time, and boarding time, were investigated.

Results: The mean of the ED occupancy rate decreased from 1.532±0.432 prior to implementation of the protocol to 1.273±0.353 after (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 LOS decreased 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) minutes to 204.1 (98.7-545.7) minutes (p<0.001). In pre-protocol period, boarding patients accumulated in the ED during the weekdays and resolved 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 boarding patients in the ED during the weekdays.
Files in This Item:
T202201840.pdf Download
DOI
10.3349/ymj.2022.63.5.470
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Min Joung(김민정) ORCID logo https://orcid.org/0000-0003-1634-5209
Kim, Ji Hoon(김지훈) ORCID logo https://orcid.org/0000-0002-0070-9568
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
Roh, Yun Ho(노윤호)
Park, In Cheol(박인철) ORCID logo https://orcid.org/0000-0001-7033-766X
Lee, Ji Hwan(이지환)
Chung, Sung Phil(정성필) ORCID logo https://orcid.org/0000-0002-3074-011X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188714
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