title: 'Delayed discharges and boarders': a 2-year study of the relationship between patients experiencing delayed discharges from an acute hospital and boarding of admitted patients in a crowded ED.
abstract: OBJECTIVE
  Many believe that hospital crowding manifesting in the ED with the boarding of admitted patients is a result of significant numbers of acute hospital beds being occupied by patients awaiting discharge to nursing homes, step-down facilities or home with or without additional support. This observational study was performed to establish the actual relationship between boarders in the ED and patients experiencing delayed discharge.
  
  
  METHODS
  Data relating to the number of patients in the ED and their points in their patient pathway were entered into a logbook on a daily basis by the most senior doctor on duty. 630 days of observations of patients boarded in the ED were compared with the number of inpatients with delayed discharges, obtained from the hospital information system, to see if large numbers of inpatients with delayed discharges are associated with crowding in the ED.
  
  
  RESULTS
  Two years of data showed an annual ED census of more than 47 000, with a daily mean ED admission rate of 29.85 patients and a daily mean ED boarding figure of 29 patients. A mean of 15.4% of the 823 hospital beds was occupied by patients with delayed discharges, and the hospital ran at, or near, full capacity (99%-105%) all the time. Results obtained highlighted a statistically significant relationship between delayed discharges in the hospital and ED crowding as a result of boarders (p value<0.001, with a regression coefficient of 0.16, 95% CI 0.12 to 0.20). The study also showed that the number of boarders was related to the number of ED admissions in the preceding 24 hours (p=0.036, with a regression coefficient of 0.14, 95% CI 0.05 to 0.28).
  
  
  CONCLUSIONS
  Delayed hospital discharges significantly contribute to crowding in the ED. Healthcare systems should target timely discharge of inpatients experiencing delayed discharge in an urgent and efficient manner to improve timely access to acute hospital beds for patients requiring emergency admission.
authors.affiliation: Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
authors.forename: Farah
authors.initials: F
authors.lastname: Mustafa
authors.affiliation: Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
authors.forename: Peadar
authors.initials: P
authors.lastname: Gilligan
authors.affiliation: Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
authors.forename: Deborah
authors.initials: D
authors.lastname: Obu
authors.affiliation: Beaumont Hospital, Dublin, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Kelly
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland 
authors.forename: Eimear
authors.initials: E
authors.lastname: O'Hea
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland 
authors.forename: Catherine
authors.initials: C
authors.lastname: Lloyd
authors.affiliation: Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
authors.forename: Sherif
authors.initials: S
authors.lastname: Kelada
authors.affiliation: Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
authors.forename: Attracta
authors.initials: A
authors.lastname: Heffernan
authors.affiliation: Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Houlihan
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data*; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007494:Ireland; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*
keywords: crowding; emergency department