title: National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency?
abstract: Boarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies.
  
  
  
  A retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering.
  
  
  
  A total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times.
  
  
  
  Urban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576-582).
authors.affiliation: 1Department of Emergency Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Jennifer S
authors.identifier: 0000-0003-2486-9352
authors.initials: JS
authors.lastname: Love
authors.affiliation: 2Department of Biostatistics and Epidemiology,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Karp
authors.affiliation: 1Department of Emergency Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: M Kit
authors.initials: MK
authors.lastname: Delgado
authors.affiliation: 4Office of the Assistant Secretary of Preparedness and Response,US Department of Health and Human Services,Washington, DC.
authors.forename: Gregg
authors.initials: G
authors.lastname: Margolis
authors.affiliation: 2Department of Biostatistics and Epidemiology,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiebe
authors.affiliation: 4Office of the Assistant Secretary of Preparedness and Response,US Department of Health and Human Services,Washington, DC.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
mesh_terms: D003430:Cross-Sectional Studies; D054597:Disaster Medicine / Q000379:methods / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data
keywords: boarding time; disaster medicine; disaster planning; emergency preparedness; health services