Association Between Long-Term Boarding in the Emergency Department and Mortality at the King Abdul-Aziz Hospital; Imad M. Khojah1, md, faaem, et al.; 2024; مقال في مجلة;
Journal of King Abdulaziz University - Medical Sciences ; ISSN: 1319-1004 ; eISSN: 1658-4279
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Imad M. Khojah1, md, faaem, Yara A. Alhjrsy2, Yasmin Nour2,Atheer Almarzouqi2, Ruba Bashawri2, Rahaf Albarraq2, Abdullah T. Mugharbel2, Ahmad H. Bakhribah1, md
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Objective: To assess the association between boarding time in the emergency department (ED) and increased patient mortality at the King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia.Methods: A retrospective study was conducted on 28,066 patients admitted through the ED and discharged from January to December 2019 at the King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia. Data on patients' demographics, age, nationality, arrival method, eligibility, triage level, and outcome (alive or dead) was collected from medical records.Results: This study found a strong link between patient mortality and boarding time, with patients who died experiencing significantly longer boarding times than those who survived. The average boarding time for those who died was more than 12 hours, compared to only 2.2% of those who did not. Additionally, the death rate was higher among non-eligible and male patients. Patients with injuries or orthopedic diseases had a notably increased likelihood of boarding for more than 12 hours. Both long-term boarding and non-eligibility for management were risk factors for death among the patients studied.Conclusion: This paper highlights the impact of protracted boarding times on patient outcomes and emphasizes the urgent need to take immediate steps to decrease ED boarding.
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Boarding, Emergency, Mortality, Mortality
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Emergency department (ED) overcrowding is a significant challenge for hospitals and is considered a hospital-wide problem[1]. It has been described as “the most serious issue confronting EDs in the developed world[2].” It is associated with poor quality of care and unfavorable events following ED assessment[3,4], leading to delays in treatment and high complication rates, which have increased the mortality rate[5–12]. Although unnecessary ED visits are thought to cause ED overcrowding, ED boarding seems to be the leading cause, characterized by patient waiting time in the ED after primary assessment and initial care[7,13,14]. ED boarding can have serious implications that are significant barriers to advanced medical treatment and lead to delays in time-sensitive procedures[14,15]. For example, the outcome in sepsis and septic shock patients can demonstrate a substantial change if seen in early target therapy[16,17]. Studies conducted in France, Greece, and Canada found that an increased length of stay and boarding in the ED is associated with increased mortality and comorbidity[17,18,19]. However, a large retrospective study showed prolonged stays in the emergency department may increase the risk of mobility problems for patients but not necessarily increase motility[20].In the Kingdom of Saudi Arabia (KSA), ED non-emergency cases are considered the leading cause of ED overcrowding, adversely affecting healthcare providers, patients, and the country’s economy[21]. In KSA culture, patients prefer to stay in the ED for better care. A 2018 study was conducted to identify the preferences of patients and their attendants regarding staying in the ED or being transferred to inpatient units. The results indicated that 59% of patients preferred staying in the ED due to the facilities and prompt attention provided by the staff. The study emphasized the importance of a timely transfer to inpatient units to reduce medical mistakes and complications, especially in overcrowded EDs. However, until now, there has not been enough data to support the idea that there is a clear relationship between an extended stay in the ED and mortality from local hospitals in KSA[22].Given the controversy surrounding the issue and the limited number of studies conducted in KSA, this retrospective study aims to examine the association between boarding time in the ED and increased patient mortality at King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia, in 2020–2021.
2.2 العيّنات
Data was collected from patients’ medical records, including demographics, age, nationality, arrival method, eligibility, outcome, triage level, and whether they died or were still alive.Statistical AnalysisData was coded, tabulated, and analyzed using SPSS version 20 (Armonk, NY: IBM Corp.). Qualitative data was expressed as numbers and percentages, and the Chi-squared test (χ2) was used to test the relationship between variables. Quantitative data was expressed as mean and standard deviation (Mean ± SD), and the Mann-Whitney test was used for non-parametric variables. Binary logistic regression was used to assess the independent predictors of death in the ED. A p-value of < 0.05 was considered statistically significant.RESULTSThe total number of patients enrolled in the study was 28,066 patients. Table 1 shows that the age of male participants was 34.17 ± 20.76 years, with 50.4% male and 78.7% Saudi nationals. 52.8% of patients had a
2.3 تحليل البيانات
Data was collected from patients’ medical records, including demographics, age, nationality, arrival method, eligibility, outcome, triage level, and whether they died or were still alive.Statistical AnalysisData was coded, tabulated, and analyzed using SPSS version 20 (Armonk, NY: IBM Corp.). Qualitative data was expressed as numbers and percentages, and the Chi-squared test (χ2) was used to test the relationship between variables. Quantitative data was expressed as mean and standard deviation (Mean ± SD), and the Mann-Whitney test was used for non-parametric variables. Binary logistic regression was used to assess the independent predictors of death in the ED. A p-value of < 0.05 was considered statistically significant.RESULTSThe total number of patients enrolled in the study was 28,066 patients. Table 1 shows that the age of male participants was 34.17 ± 20.76 years, with 50.4% male and 78.7% Saudi nationals. 52.8% of patients had a
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The authors have no conflicts of interest to declare. All co-authors have seen and agreed with the manuscript’s contents, and there is no financial interest to report. The authors certify that the submission is an original work and is not under review at any other publication.
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