Introduction
Emergency department (ED) boarding is when admitted patients are kept at the ED for extended periods until an inpatient bed becomes available. This practice has been listed as one of the main contributing factors to crowding in emergency departments, resulting in detrimental effects by augmenting the likelihood of medical inaccuracies, interruptions in treatment administration, and an overall diminished eminence of care. Globally, insufficient inpatient capacity and ED crowding are critical concerns, and it is indeed challenging to maintain innocuous and appropriate care for patients amid crowded circumstances. In psychiatry emergency care, ED boarding, as a result of the scarcity of therapeutic resources and available settings, has led to delays in the initiation of treatment, leading to downstream effects on other emergency amenities such as police and emergency medical facilities. Furthermore, studies have unraveled that mature adults are a high-risk group for adverse events since they are frequent emergency department users and are more prone to the negative effects of ED crowding.
Medication Mismanagement
Studies have associated medication interruptions and adverse events among boarded and non-boarded emergency department patients. The results indicated that the chances of home-based treatment deferrals in boarded individuals were more significant than in non-boarded individuals. Jiraporn et al. (2014) examined files from health record evaluation and managerial catalogs at two infirmaries. The researchers related the occurrence of proceedings for the period of ED boarding to that of while the patient was in an inpatient unit. It was discovered that among 1431 patient files, there were 1016 events. These results indicated that treatment interruptions and adverse occurrences were more pronounced when boarding in the ED when matched to an inpatient department (Jiraporn et al., 2014).
There are multiple explanations for this; for instance, there is a chance that EPs might regard boarding patients as being examined already and admitted with a prior plan of treatment already enacted. Therefore, they may shift their focus to new ED patients (Jiraporn et al., 2014). Also, EPs are usually not proficient when it comes to the management of chronic ailments resulting in overdue home treatments. Finally, ED boarding is commonly linked to crowding; therefore, the occurrence of boarding patients may point out a packed ED that additionally constrains the period the health worker has to concentrate on a specific individual.
Another study by Shan et al. (2009) aimed to define the prevalence of detrimental occurrences among ED-boarding patients and found that a significant regularity of adverse events occurred when patients were boarded in the ED. These occasions were more pronounced in elderly citizens or the ones with comorbidities (Shan et al., 2009). The explanation could be that older patients are more likely to have more medication, thereby increasing the chances of missing medication while boarding. Additionally, sicker and older patients have higher chances of undesirable events like hypoxia and arrhythmias as a result of their underlying medical conditions, hence suboptimal to leave them boarding in the ED (Shan et al., 2009). Emergency GPs usually get preoccupied with the flow of patients as crowding increases, which often leads to insufficient attention to the borders.
Non-Adherence to Best Available Evidence
Patients with extended ED stays can potentially have worse outcomes and lower quality of care. This is according to a study conducted by Deborah et al., (2007), which analyzed data from an observational registry and resolved that extensive ED stays were linked to lessened utilization of guideline-recommended remedies, and patients had an augmented risk of developing complications such as recurrent myocardial infarction. Indeed, it has been postulated that lengthy ED stay may lead to decreased quality of care offered and interruption in the carrying out of inpatient guidelines (Deborah et al., 2007). The study also looked at the relationship between ED stay and acute treatments and outcomes, concluding that there was no link between augmented mortality and an extended ED stay.
Risk of Developing Complications
Prolonged stay in the emergency department has also been concomitant to the risk of developing complications such as pressure ulcers and delirium. In a study conducted by Dongkwan et al., (2019), it was discovered that protracted ED stay for over 12 hours is an autonomous risk factor for developing pressure ulcers. Indeed, the ED setting might not be optimal enough for inclusive preventive care to guard patients against developing foot ulcers, as overcrowding might overwhelm the healthcare providers, making it difficult for them to adhere to the recommended patient turning periods (Dongkwan et al., 2019). This often leads to complications such as stroke, sepsis, acute coronary syndrome, cardiac arrest and even death, and significantly increasing the cost of care.
Mario et al., (2016), conducted a study to determine the relationship between the ED period of stay before admission and the incidence of delirium in older medical patients. The study participants were 75 years and above, concluding that the period of stay for more than ten hours was linked to more risk of delirium in admitted individuals. Elderly patients are regularly sick and need extensive examinations with more hospitalizations than their younger counterparts (Mario et al., 2016). Furthermore, aged adults require a better level of urgency and a more extended stay and are at amplified risk of adverse events like delirium. The condition is common among hospitalized older patients and is associated with more short- and long-term death and more necessity for official care and health expenses.
Negative Impact on Patient Experience
Patients require accurate and emphatic interpersonal communication as this allows them to manage their apparent ailment and condition. Correctly executing this makes it probable for patients to bear unpleasant experiences, especially during extensive waiting periods. According to a study conducted by Rantala et al., (2021), in an overcrowded boarding setting, there is a violation of most of the conditions for professional ethics, leading to significant ethical tension among healthcare personnel concerned and hence resulting in a negative impact on patient experience (Rantala et al., 2021). There is an infringement of the basic freedoms of an individual as a human being and a violation of most of the seven conditions of professional ethics.
Chin-Yen et al., (2016), conducted a study to appreciate the familiarities and apprehensions of individuals in the emergency department during inpatient boarding. It was discovered that insufficient hospital beds led to increased discontent among patients and family members (Chin-Yen et al., 2016). Additionally, it resulted in a rise in death rates, the length of admission, errors in treatment administration and side effects. Longer boarding time was associated with more significant stress for the healthcare providers, patients and family members, negatively impacting the patient experience.
Conclusion
However, a study conducted by Lord et al., (2018) did not establish adverse hospitalization outcomes associated with ED boarding within the initial 24 hours of hospital admission to a standard medicinal service. The study was conducted in a solitary urban academic infirmary that may not comprehensively portray what goes on in most hospitals worldwide. Furthermore, most studies suggest poor outcomes and adverse events due to overcrowding and boarding in the ED. There is a need for further investigation into the phenomenon for better understanding and for the development of actual solutions to tackle the issue. Indeed, it is incumbent for healthcare providers to ensure that they provide the best possible care for patients who experience emergency department boarding.
References
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