Background: With sepsis as a leading cause of morbidity and mortality in hospitalized patients, it is important to assess what factors may be contributing to this. Emergency department (ED) boarding has been shown to be associated with several negative patient-oriented outcomes. The primary goal of this study is to assess the effect of ED boarding on patient outcomes in patients admitted to the hospital with sepsis. We hypothesized that ED boarding of patients with sepsis would be associated with increased inpatient mortality and hospital length of stay (LOS).
Methods: This was a retrospective cohort study at a tertiary urban medical center conducted from January 1, 2016 through December 31, 2016. Inclusion criteria were adult subjects ≥ 18 years of age who were diagnosed with sepsis in the ED and were subsequently admitted to the hospital. Patient demographics, severity of illness, hospital LOS, and mortality were collected. ED Boarding was defined as a period of time greater than 3 hours from the time of admission decision to the time that the patient physically left the ED. The data was evaluated using descriptive statistics, Pearson correlation, linear and logistic regression analysis, Chi-square test for independence, and ANOVA.
Results: Of the initial population of 2,034 patients identified only 1,841 patients were included via inclusion and exclusion criteria. Average patient age was 67 years with a male predominance of 52%. 55% of patients experienced ED boarding with an average ED boarding time of 10.5 hours. Overall mortality was 11.6%. Mortality for patients who were not boarding in the ED and those who were boarding in the ED was 11.40% and 12.10%, respectively (p=0.67). Overall, median hospital LOS for patients admitted for sepsis was 5.9 days. There was a positive association between longest ED boarding time of > 24 hours and increased hospital LOS at 6.9 days (p=0.01).
Conclusion: In this study of adult patients diagnosed with sepsis and admitted to the hospital, ED boarding was associated with increased hospital LOS, but was not associated with an increase in mortality. These findings underscore the importance of prompt recognition and aggressive treatment of septic patients who present to the ED, while highlighting the fact that expeditious transfer of admitted patients to inpatient units improves their hospital throughput.