Transfer boarding delays care more in low-volume rural emergency departments: A cohort study
Abstract
Purpose: Emergency department (ED) crowding is increasing and is associated with adverse patient outcomes. The objective of this study was to measure the relative impact between ED boarding on timeliness of early ED care for new patient arrivals, with a focus on the differential impact in low-volume rural hospitals. Methods: Retrospective cohort of all patients presenting to a Veterans Health Administration (VHA) ED between 2011–2014. The primary exposure was the number of patients in the ED at the time of ED registration, stratified by disposition (admit, discharge, or transfer) and mental health diagnosis. The primary outcome was time-to-provider evaluation, and secondary outcomes included time-to-EKG, time-to-laboratory testing, time-to-radiography, and total ED length-of-stay. Rurality was measured using the Rural-Urban Commuting Areas. Findings: A total of 5,912,368 patients were included from all 123 VHA EDs. Adjusting for acuity, new patients had longer time-to-provider when more patients were in the ED, and patients awaiting transfer for non-mental health conditions impacted time-to-provider for new patients (16.6 min delays, 95%CI 12.3–20.7 min) more than other patient types. Rural patients saw a greater impact of crowding on care timeliness than non-rural patients (additional 5.3 min in time-to-provider per additional patient in ED, 95%CI 4.3–6.4), and the impact of additional patients in all categories was most pronounced in the lowest-volume EDs. Conclusions:…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 5,912,368 participants or records.
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