December Journal: ED Boarding’s Impact on Patient Care and Clinician Well-Being

Emergency department (ED) boarding, or continuing to provide care for patients in the ED after the decision to admit due to lack of inpatient bed availability, is a long-standing yet increasingly common quality and safety issue. ED boarding is associated with delayed and missed care, medication errors, delirium, higher morbidity and in-hospital mortality, and longer hospital length of stay as well as poor patient satisfaction.

A new study from the December 2023 issue of The Joint Commission Journal on Quality and Patient Safety conducted a cross-sectional survey with ED attending physicians, resident physicians, advanced practice providers and nurses to obtain their insights into the quality and safety of patient care delivered to ED boarding patients, as well as clinician safety and satisfaction related to ED boarding care. Semi-structured focus group interviews with a subsample of participants also were conducted to help interpret survey data and identify areas of improvement in boarding care.

A total of 94 questionnaires were obtained. Clinicians reported that boarding highly contributed to the perception of burnout, as well as high rates of perceived verbal and/or physical abuse from boarding patients. A total of 39 clinicians participated in focus groups on the topic of boarding care and six themes were identified:

• Clinicians perceived that ED boarding leads to increased patient safety events.
• Clinicians desired standardization for the boarding care process.
• Clinicians felt they lacked knowledge, resources and training to care for boarding patients.
• Clinicians desired proactive bed and resource planning for boarding patients.
• Clinicians advocated for improved communication among the team and to patients.
• Clinicians identified a need for culture change regarding boarding care.

Participants overwhelmingly felt that boarding patients received poorer care due to concerns of poor patient safety communication and a lack of training, resources and training. Possible solutions identified include standardization of care, proactive planning and culture change.

“While the importance of clinician burnout cannot be dismissed, the most important impact of boarding is on the patients and families who rely on the emergency department,” notes an accompanying editorial by Richelle J. Cooper, MD, MSHS and David L. Schriger, MD, MPH. “Boarding results in poor quality care and patient harm, not just for the admitted patients waiting for an inpatient bed but for all patients seeking care in the ED.”

Also featured in the December issue are:

• Does Suicide Risk Screening Improve the Identification of Primary Care Patients Who Will Attempt Suicide Versus Depression Screening Alone? (Data from six military primary care clinics)
• Screening for Suicide Risk Is Predicting the Future, Not Diagnosing the Present (editorial)
• A Proposed Approach to Allegations of Sexual Boundary Violation in Health Care (Data from a 200-hospital professional accountability collaborative)
• Long-Term Sustainability and Adaptation of I-PASS Handovers (Massachusetts General Hospital, Boston)
• Improving Diabetes Screening Through Quality Improvement Change (Johns Hopkins University School of Medicine, Baltimore, Maryland)
• Key Strategies to Publishing Your Quality Improvement Work
• Improving the Format, Content, and Writing Process of Outpatient Clinic Letters Within a Musculoskeletal Therapy Department (Sussex Community NHS Foundation Trust, Brighton, United Kingdom)
• Learning from Latent Safety Threats Identified During Simulation to Improve Patient Safety (Advocate Aurora Health, Oakbrook Terrace, Illinois)
• Sentinel Event Alert 67: Preserving Patient Safety After a Cyberattack (The Joint Commission, Oakbrook Terrace, Illinois)

For more information, please visit the JQPS website.