title: A mixed-methods study of the quality of care provided to patients boarding in the emergency department: comparing emergency department and inpatient responsibility models.
abstract: Concern exists regarding care patients receive while boarding (staying in the emergency department [ED] after a decision to admit has been made). This exploratory study compares care for such ED patients under "Inpatient Responsibility" (IPR) and "ED Responsibility" (EDR) models using mixed methods. The authors abstracted quantitative data from 1,431 patient charts for ED patients admitted to two academic hospitals in 2004-2005 and interviewed 10 providers for qualitative data. The authors compared delays using logistic regression and used provider interviews to explore reasons for quantitative findings. EDR patients had more delays to receiving home medications over the first 26 hours of admission but fewer while boarding; EDR patients had fewer delayed cardiac enzymes checks. Interviews revealed that culture, resource prioritization, and systems issues made care for boarded patients challenging. A theoretically better responsibility model may not deliver better care to boarded patients because of cultural, resource prioritization, and systems issues.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Zero Emerson, Boston, MA 02114, USA. sliu1@partners.org
authors.forename: Shan W
authors.initials: SW
authors.lastname: Liu
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Joel S
authors.initials: JS
authors.lastname: Weissman
authors.forename: Kathleen
authors.initials: K
authors.lastname: Walsh
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Deal
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010343:Patient Admission / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration*; D012941:Social Responsibility; D014481:United States