title: Boarding admitted children in the emergency department impacts inpatient outcomes.
abstract: OBJECTIVE
  This study aimed to assess the relationship between boarding of admitted children in the emergency department (ED) and cost, inpatient length of stay (LOS), mortality, and readmission.
  
  
  METHODS
  This was a retrospective study of 1,792 pediatric inpatients admitted through the ED and discharged from the hospital between February 20, 2007 and June 30, 2008 at a major teaching hospital with an annual ED volume of 40,000 adult and pediatric patients.The main predictor variable was boarding time (time from admission decision to departure for an inpatient bed, in hours). Covariates were patient age, payer group, times of ED and inpatient bed arrival, ED triage acuity, type of inpatient service, intensive care unit admission, surgery, and severity of inpatient illness. The main outcome measures, cost (dollars) and inpatient LOS (hours), were log-transformed and analyzed using linear regressions. Secondary outcomes, mortality and readmission to the hospital within 72 hours of discharge, were analyzed using logistic regression.
  
  
  RESULTS
  Mean ED LOS for admitted patients was 9.0 hours. Mean boarding time was 5.1 hours. Mean cost and inpatient LOS were $9893 and 147 hours, respectively. In general, boarding time was associated with cost (P < 0.001) and inpatient LOS (P = 0.01) but not with mortality or readmission. Longer boarding times were associated with greater inpatient LOS especially among patients triaged as low acuity (P = 0.008). In addition, longer boarding times were associated with greater probability of being readmitted among patients on surgical services (P = 0.01).
  
  
  CONCLUSIONS
  Among low-acuity and surgical patients, longer boarding times were associated with longer inpatient LOS and more readmissions, respectively.
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0110, USA. bekmeziana@peds.ucsf.edu
authors.forename: Arpi
authors.initials: A
authors.lastname: Bekmezian
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006784:Hospitals, Teaching / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D005791:Patient Care / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D010359:Patient Readmission; D011787:Quality of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome