Emergency Department Access Block: The Impact on Care of Boarding Admitted Children

Background:

Emergency department (ED) access block is rapidly becoming a significant problem for children. ED access block is defined by total ED time > 8 hours because of an insufficient number of inpatient beds and has been linked to ED overcrowding, medical errors, and poor patient outcomes in adult patients; however, the impact of access block on subsequent hospitalization for children has never been systematically studied. The objective was to assess the relationship between ED access block and inpatient cost, length of stay (LOS), and other characteristics of hospitalization for children.

Methods:

We conducted a retrospective study of pediatric patients admitted Ihrough the ED at a major tertiary‐care, nonprofit, teaching children's hospital caring for large numbers of medically complex patients. We combined data from the ED medical record information system and the financial billing records for all 826 patients admitted through the ED during a 13‐month period (February 2007‐March 2008). Outcome measures included inpatient LOS, actual variable direct cost, mortality, 3‐day hospital readmission, and intensive care unit admission. We conducted bivariate and multivariate analyses to assess the relationship between these outcomes and independent predictors including time of ED arrival, total ED time, ED acuity rating, inpatient severity rating, patient age, payer, and type of inpatient service.

Results:

Mean ED boarding time for admitted patients was 9.4 hours. Forty‐six percent of patients experienced access block, whereas 23% were boarded for more than 12 hours. Average cost and LOS were $11,700 and 7.3 days, respectively. In bivariate and multivariate regressions, we found no association between access block and cost, LOS, mortality, 3‐day readmission, or intensive care unit admission rates. Total ED time and time of ED arrival were also not associated with outcomes (all P values > 0.05).

Conclusions:

In our institution, access block in the ED occurs frequently. However, prolonged boarding of pediatric patients does not seem to be associated with increased inpatient cost, length of stay, mortality, readmission, or intensive care unit admission. Our single‐institution finding must be confirmed on a larger scale. Nevertheless, our study underlines the need to further examine the causes and effects of ED access block in pediatric populations.

Author Disclosure:

A. Bekmezian, none; P. J. Chung, none.