Transfer boarding delays care more in low‐volume rural emergency departments: A cohort study

Nicholas M. Mohr; Chaorong Wu; Michael J. Ward; Candace D. McNaughton; Brett Faine; Kaila Pomeranz; Kelly Richardson; Peter J. Kaboli

doi:10.1111/jrh.12559

Back

Transfer boarding delays care more in low‐volume rural emergency departments: A cohort study

Journal article

Peer reviewed

Transfer boarding delays care more in low‐volume rural emergency departments: A cohort study

Nicholas M. Mohr, Chaorong Wu, Michael J. Ward, Candace D. McNaughton, Brett Faine, Kaila Pomeranz, Kelly Richardson and Peter J. Kaboli

The Journal of rural health, Vol.38(1), pp.282-292

01/2022

DOI: 10.1111/jrh.12559

PMCID: PMC8715860

PMID: 33644911

Files and links (1)

url

https://www.ncbi.nlm.nih.gov/pmc/articles/8715860View

Open Access

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 of 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: A retrospective cohort of all patients presenting to a Veterans Health Administration (VHA) ED between 2011 and 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 nonmental 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 nonrural 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: Patients seen in EDs with more crowding have small, but additive, delays in early elements of ED care, and transferring patients with nonmental health diagnoses from rural facilities were associated with the greatest impact.

Details

Title: Subtitle: Transfer boarding delays care more in low‐volume rural emergency departments: A cohort study
Creators: Nicholas M. Mohr - Roy J. and Lucille A. Carver College of Medicine
Chaorong Wu - University of Iowa
Michael J. Ward - Vanderbilt University Medical Center
Candace D. McNaughton - Vanderbilt University Medical Center
Brett Faine - University of Iowa
Kaila Pomeranz - University of Iowa
Kelly Richardson - Iowa City VA Health Care System
Peter J. Kaboli - University of Iowa
Resource Type: Journal article
Publication Details: The Journal of rural health, Vol.38(1), pp.282-292
DOI: 10.1111/jrh.12559
PMID: 33644911
PMCID: PMC8715860
NLM abbreviation: J Rural Health
ISSN: 0890-765X
eISSN: 1748-0361
Language: English
Date published: 01/2022
Academic Unit: Epidemiology; Emergency Medicine; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9984295960702771

Metrics

7 Record Views

2 Times Cited - Web of Science