title: Boarding is associated with higher rates of medication delays and adverse events but fewer laboratory-related delays.
abstract: BACKGROUND
  Hospital crowding and emergency department (ED) boarding are large and growing problems. To date, there has been a paucity of information regarding the quality of care received by patients boarding in the ED compared with the care received by patients on an inpatient unit. We compared the rate of delays and adverse events at the event level that occur while boarding in the ED vs while on an inpatient unit.
  
  
  METHODS
  This study was a secondary analysis of data from medical record review and administrative databases at 2 urban academic teaching hospitals from August 1, 2004, through January 31, 2005. We measured delayed repeat cardiac enzymes, delayed partial thromboplastin time level checks, delayed antibiotic administration, delayed administration of home medications, and adverse events. We compared the incidence of events during ED boarding vs while on an inpatient unit.
  
  
  RESULTS
  Among 1431 patient medical records, we identified 1016 events. Emergency department boarding was associated with an increased risk of home medication delays (risk ratio [RR], 1.54; 95% confidence interval [CI], 1.26-1.88), delayed antibiotic administration (RR, 2.49; 95% CI, 1.72-3.52), and adverse events (RR, 2.36; 95% CI, 1.15-4.72). On the contrary, ED boarding was associated with fewer delays in repeat cardiac enzymes (RR, 0.17; 95% CI, 0.09-0.27) and delayed partial thromboplastin time checks (RR, 0.54; 95% CI, 0.27-0.96).
  
  
  CONCLUSIONS
  Compared with inpatient units, ED boarding was associated with more medication-related delays and adverse events but fewer laboratory-related delays. Until we can eliminate ED boarding, it is critical to identify areas for improvement.
authors.affiliation: Emergency Department, Massachusetts General Hospital, Boston, MA.
authors.forename: Jiraporn
authors.initials: J
authors.lastname: Sri-On
authors.affiliation: Emergency Department, Massachusetts General Hospital, Boston, MA.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Emergency Department, Massachusetts General Hospital, Boston, MA.
authors.forename: David P
authors.initials: DP
authors.lastname: Curley
authors.affiliation: Emergency Department, Massachusetts General Hospital, Boston, MA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Brigham and Women's Hospital, Boston, MA.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Weissman
authors.affiliation: Harvard School of Public Health, Boston, MA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
authors.affiliation: Emergency Department, Massachusetts General Hospital, Boston, MA. Electronic address: sliu1@partners.org.
authors.forename: Shan W
authors.initials: SW
authors.lastname: Liu
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000368:Aged; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine / Q000592:standards / Q000706:statistics & numerical data; D004358:Drug Therapy / Q000592:standards*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D010314:Partial Thromboplastin Time; D011787:Quality of Health Care / Q000706:statistics & numerical data; D013997:Time Factors