title: Emergency department overcrowding and inpatient boarding: a statewide glimpse in time.
abstract: OBJECTIVE
  This was a point-prevalence study designed to quantify the magnitude of emergency department (ED) overcrowding and inpatient boarding. Every ED in Michigan was surveyed at a single point in time on a Monday evening. Given the high patient volumes on Monday evenings, the effect on inpatient boarding the next morning was also reviewed.
  
  
  METHODS
  All 134 EDs within the state of Michigan were contacted and surveyed on Monday evening, March 16, 2009, over a single hour and again the following morning. Questions included data on annual census, bed number, number of admitted patients within the ED, ambulance diversion, and ED length of stay.
  
  
  RESULTS
  Data were obtained from 109 of the 134 (81%) hospitals on Monday evening and 99 (74%) on Tuesday morning. There was no difference in annual visits or ED size between participating and nonparticipating EDs. Forty-seven percent of EDs were boarding inpatients on Monday evening, compared with 30% on Tuesday morning. The mean estimated boarding times were 3.7 hours (Monday evening) and 7.2 hours (Tuesday morning). Twenty-four percent of respondents met the definition of overcrowded during sampling times. There was a significant relationship between inpatient boarding and ED overcrowding (p < 0.001). Only three EDs were actively diverting ambulances.
  
  
  CONCLUSIONS
  In this study on a single Monday evening, 47% of EDs in Michigan were actively boarding inpatients, while 24% were operating beyond capacity. On the following morning (Tuesday), EDs had fewer boarded inpatients than on Monday evening. However, these boarded inpatients remained in the ED for a significantly longer duration.
authors.affiliation: Department of Emergency Medicine, Michigan State University, East Lansing, USA. feltonbr@gmail.com
authors.forename: Brent M
authors.initials: BM
authors.lastname: Felton
authors.forename: Earl J
authors.initials: EJ
authors.lastname: Reisdorff
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Krone
authors.forename: Gus A
authors.initials: GA
authors.lastname: Laskaris
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data*; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008824:Michigan; D010343:Patient Admission / Q000706:statistics & numerical data; D011787:Quality of Health Care; D018570:Risk Assessment; D013997:Time Factors