Effect of Emergency Department Boarding on ICU Length of Stay and In-Hospital Mortality; A Retrospective Cohort Study.

Abstract

One of the main contributing factors of emergency department (ED) crowding is ED patient boarding. This study aimed to assess the factors influencing length of stay (LOS) in intensive care unit (ICU) and in-hospital mortality (IHM) among ICU-admitted ED boarded cases. A retrospective cohort study was conducted on adult patients at a tertiary care hospital in Lebanon who required ICU admission and stayed for 6+ hours in the ED during one year. The independent predictive factors of LOS in ICU and IHM were studied using multivariable logistic regression analysis. Out of 583 patients (mean age 69.5 years; 61.6% male), 12.8% died in hospital. 25.5% had a prolonged ICU stay (≥7 days) with a median LOS of 3 days. Prolonged ICU LOS was associated with previous cancer diagnosis (adjusted odds ratio (aOR)=1.66), prehospital bedridden status (>5 days, aOR=4.41), ED vasopressor use (aOR=1.86), extended ED boarding (aOR=1.03), IHM (aOR=3.37), and not being married (aOR=2.0). IHM was associated with abnormal Modified Shock Index at ED triage (aOR=7.35), ED mechanical ventilation use (aOR=6.07), ED triage Shock Index ≥1.3 (aOR=18.25), and long ICU stay (aOR=7.48). ED-triage Saturation of Peripheral Oxygen (SPO) level was negatively associated with IHM (aOR=0.89). It seems that, ED boarding of ICU patients is associated with an increase in ICU LOS, which is associated with an increase in IHM. Hospitals should allocate resources to reduce ED boarding and improve outcomes for critically ill patients.