Department of Emergency, Urmia University of Medical Sciences, Urmia, Iran.
Department of General Surgery, Tabriz University of Medical Science, Tabriz, Iran.
Chin J Traumatol. 2020 Dec;23(6):346-350. doi: 10.1016/j.cjtee.2020.09.002. Epub 2020 Sep 9.
Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center.
All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test.
Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age.
The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.
住院是急诊科（ED）常见的问题，与医疗质量差和结果不良有关。伊玛目霍梅尼医院是伊朗西北部乌尔米亚大都市的主要医疗中心。由于人满为患和患者数量过多，我们旨在描述该中心 ED 中住院的发生率、原因和后果。
回顾性分析 2017 年 8 月 1 日至 2018 年 8 月 1 日期间到伊玛目霍梅尼医院 ED 就诊的所有患者的病历。排除记录不完整的患者。将住院定义为在入院后 2 小时以上仍无法将已入院的 ED 患者转移到下游病房。收集并分析人口统计学数据、住院率、死亡率和通过紧急严重指数评估的分诊级别（1-5 级）。将患者的首次就诊时间分为 4 个范围：0:00-5:59、6:00-11:59、12:00-17:59 和 18:00-23:59。进行描述性、参数和非参数统计检验，并通过 Pearson Chi-square 检验确定住院风险。
人口统计学数据分析显示，共有 1608 名患者，其中 941 名（58.5%）为男性，667 名（41.5%）为女性。5 名患者（0.3%）死亡。1-5 级分诊患者的分布分别为 79 名（4.9%）、1150 名（71.5%）、374 名（23.3%）、4 名（0.2%）和 0 名（0%）。大多数患者为 2 级。仅 75 名（4.7%）患者需要重症监护。大多数患者（84.2%）在工作日就诊。最大的患者负荷出现在 12:00-17:59 之间。在 1608 名患者中，340 名（21.1%）在平均入院时间 13.70 小时内经历了住院。在 340 名住院患者中，20.1%属于外科，12.1%属于骨科，10.9%属于神经外科，10.3%属于神经内科。女性、需要重症监护和分诊级别较低的患者住院率较高。与未住院的患者相比，住院的患者年龄更大。
老年和女性患者的住院率较高。此外，住院取决于下游病房科室：需要手术治疗的患者经历的住院率最高。
