Healthcare Assignment: Literature Survey on ED Boarding

This healthcare assignment presents a literature review focusing on the issue of emergency department (ED) boarding. The review explores the negative patient-oriented outcomes associated with ED crowding, such as reduced patient satisfaction and increased mortality rates. The study analyzes a retrospective cohort study that examined the relationship between the length of ED boarding and patient outcomes. The results indicate that prolonged ED boarding is linked to increased hospital length of stay and higher mortality rates. The assignment discusses the implications of these findings, highlighting the need for alternative plans to avoid compromised patient care and improve outcomes. The report also examines the methodology, data collection, analysis techniques, and the study's potential contribution to the healthcare field, emphasizing the importance of addressing ED boarding to enhance patient care and reduce adverse outcomes.

Running head: HEALTHCARE ASSIGNMENT
HEALTHCARE ASSIGNMENT
Name of the Student
Name of the University
Author Note

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Literature survey
For the purpose of conducting a literature survey, several databases were searched for
like Google scholar, Pubmed, ResearchGate and others. For this purpose the specific keywords
that were used included the words pertaining to the given topic “Emergency room boarding”.
Hence these words were searched for in the above mentioned databases. Filter as applied in
terms that only quantitative study was required for this particular research and critical appraisal.
The purpose of literature review or literature survey is in the context of a scholarly paper is based
on the fact that it helps to review the current knowledge which includes the substantial findings
along with the methodological and the theoretical contributions associated with the given topic.
The topic that this study deals with is associated to the issues of emergency department
boarding. According to the previous studies, it has been seen that there is an association of the
emergency department (ED) with the various negative patient-oriented outcomes which is often
related to the lack of patient satisfaction to the increased rate of inpatient mortality (Sun et al.,
2013). The issues related to Emergency department crowding along with the inpatient capacity
which is inadequate, which comprises the most significant issues in terms of hospital care in
recent times. According to the studies, the cause of ED crowding is the periodic mismatches that
includes the bed space and the staff that are insufficient (Viccellio et al., 2013). The
manifestation caused by ED crowding depends on the wait for patients which is seen by the
providers along with the rate of patients, who are not observed by the doctors yet, longer stays in
the ED, and longer wait-times before inpatient bed placement (White et al., 2013). Reasons for
the focus on the amount of ED crowding which is only undesirable due to the patients however
the ED crowding is often seen to be related the delays in the administration of important

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medications along with the higher rates of complications that occurs after ED evaluation that in
turn leads to an elevated rate of mortality.
Critical appraisal
Type of qualitative research design
A retrospective cohort study was conducted as a qualitative research which aimed to
explore the association that was present between that of the length of ED boarding and outcomes
which were related to the boarded ED patients at a single hospital (Singer et al., 2013).
Results valid/trustworthy and credible
The results were credible as the study was able to develop a unique system that helped to
deal with the Emergency department crowding. Additionally the research involved the use of the
electronic medical record (EMR) system which was implemented for the purpose of extracting
the demographics of the patients along with the clinical data for each of the patient involved in
the study.
Participants chosen
All the participants involved in the study were patients or suffers, who were admitted to
the healthcare facility through the Emergency department and were cleared from the hospital
within the October 2005 and September 2008. All of these individuals were involved in the
study. The exclusion standards included lack of information regarding the LOS, misplaced data
of ICU admission, in-hospital mortality and others (Pitts et al., 2014).
Accuracy and completeness of data assured

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In order to ensure the accuracy of the obtained data, the study used the descriptive
statistics analysis which in turn was used for the evaluation of the association of the ED boarding
length and that of the consequent transfer to an ICU, increased stay in healthcare facility and
ultimately mortality. For the purpose of ensuring the completeness of the data obtained logistic
deterioration that was used to recognize the aspects which are connected with mortality within
healthcare facility and admission to ICU, on the other hand direct deterioration was used to
report the features that were connected with inpatient amplified length of stay (Mumma et al.,
2014).
Implications of the research
The results of this research implies that with the increase in the length of the ED boarding
there is also an increase in the negative impacts on the patient in terms of the outcomes like
mortality and hospital LOS. These results indicates the direct relationship that was present
between the patient outcomes and associated boarding.
May new insights increase sensitivity to others’ need?
The new insights are helpful in increasing the sensitivity to others’ need since this helps
to make the patients understand that continued boarding has several after-effects on other
patients admitted to the emergency department who were still waiting for their care process.
Hence, it was evident that the increased number of boarders were directly associated to the
negative patient oriented outcomes (Misek, DeBarba & Brill, 2015).

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Understandings enhance situational competence
The above mentioned situations in turn lead to certain situations where there is a delay in
the antibiotics, followed by the delay in the administration of the pain medications. There is also
an association with the reduction in the patient satisfaction along with the delays that are caused
in the abdominal computed tomography results. The other situations that might arise are a result
of the prolonged periods of disposition in the patients who are suffering from asthma. In certain
cases there are also higher rates of complication in case of the acute coronary syndrome which is
also known as ACS and non- Acute coronary syndrome and associated chest pain. There are also
incidences of an increased rate of the ventilator-associated pneumonia in the patients admitted in
the trauma department of the hospitals through the Emergency Department (Zeller, Calma &
Stone, 2014).
Effect on the reader
The readers of this study are able to understand the association that exists between the
Emergency department or ED boarding and the stretch of stay in the hospital along with
increased mortality. The readers are able to understand that the enhanced rate of in-hospital
mortality as well as lengthy hospital stays may be due to a growth in the injury or health severity
and is not associated to the straight result of extended boarding. However it is also important to
know that ED boarders are at an elevated hazard of poor patient consequences, in association
with the alternative plans which must be made for the purpose of taking care for them in order to
avoid compromised care (Coil et al., 2016).

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Is the reader imaginatively drawn to the experience?
The above mentioned scenarios are able to draw attention towards the prevailing
scenarios and make them imagine the experience which in turn might be helpful for the
development of alternative plans which must be made to take good care of the patients so that
they are able to avoid care which is of compromised nature.
Results of the study
There were 41,256 patients or clients that were admitted through ED. Further, mortality
also clearly amplified with rise in the time of boarding, from 2.5% in-patients boarded within 2
hours and compared to the 4.5% in-patients boarding for more than 12 hours (p < 0.001). The
mean hospital length of stay or increased stays also provided an upsurge with the time of
boarding (p < 0.001), from 5.6 days (SD ± 11.4 days) in the patients, who admitted in the
department of emergency for fewer than 2 hours to 8.7 days (SD ± 16.3 days) who were in the
department of emergency for more than 24 hours. This increase was ostensible after alteration
were done for the comorbid conditions and other influential factors (Singer et al., 2013).
Research approach fit the purpose of the study
The study focuses on the relation that exists between the connotation between the time of
boarding and deviated mortality within the healthcare facility and the length of stay for those
who admitted to the healthcare facility, there is an ample amount of evidences that determine that
lengthy effects of boarding many other ED patients, who are waiting for care.

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Data collection and analysis techniques appropriate
An Electronic Medical Record (EMR) system was implemented for the purpose of
extraction of the patient demographics along with ED disposition that included the process of
discharge, admit to the healthcare facility along with Emergency department and Length of stay
within the healthcare facility, and mortality within the facility. The process of Boarding could be
defined as ED and the LOS within the facility which involves 2 hours or more after the choice
for admission. This was followed by descriptive statistics which was generally used to estimate
the connotation between the dimension of emergency department boarding and hospital LOS,
ensuing the transmission to the intensive care unit (ICU), as well as a mortality controlling for
associated comorbidities (Singer et al., 2013).
Significance/importance of the study
The results that were obtained was able to recommend that prolonged ED boarding was
seen to be associated with decreases clinical importance for patient outcomes such as hospital
length of stay and associated mortality. The obtained conclusions were comparable to the recent
studies that helped in the demonstration that boarding was associated with the negative effects in
a uniform manner.
Study’s potential contribution

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The study focuses on the relation that exists between boarding and hospital mortality as
well as the LOS for those admitted to the hospital. Further it also presented several evidences
that determined that the prolonged effects of boarding on other emergency department patients
waiting for their care process in various ways both physically and mentally.
The sampling process is clear or not as well as the study needs
Yes, it is found from the study that the method of sampling is proper and is directed by
the requirements of the study.
Does the people controlling the research control selection of the sample?
It is not properly explained in the study that how the researcher is able to control the
collection of the sample.
Do sample size and composition reflect the study needs?
During the study, total 42,149 patients admitted from the ED as per the collected research
data and within that 893 (2.1%) were omitted from data as the data of those research was
missing, resulting ultimately in 41,256 cases that was used in the analysis process. Hence, the
Sample size were ample to conduct the study and the sample provided complete details to
conclude it as the successful study procedure.

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Is the phenomenon (human experience) clearly identified?
No, the phenomenon of human experience is not presented in a clear way.
Are data collection procedures clear?
The process of the collection of the data is not described in an explicit or detailed
manner. However it is mentioned that the processes of comorbidity were used to regulate for
differences in case mix.
Are researcher roles and activities explained?
The study does not provide an explicit role of the researchers. However it can be
understood from the study that the activities like data collection and data analysis are conducted
by the researchers involved.
Are data analysis procedures described?
Yes, the process of data analysis is presented in an explicit manner which shows all the
methods which were employed for the purpose of analysis of the data that were obtained through
the study.
Does analysis guide directions of sampling when it ends?
When the sampling ends, the method of analysis is able to guide the directions of
sampling since the generalized methods of estimating equation were implemented and used in

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order to provide explanation for the collection effects of patients along with the repetitive visits
of the families of the patients.
Are data management processes described?
The paper does not provide a full process in which the data is managed since this study
represents a reflective review of a large computerized database.
What are the reported results (descriptive or interpretation)?
Through the process it was determined that ED boarding was related to advanced
inpatient mortality amounts and lengthier hospital length of stay in this healthcare facility.
Further, hard work to decrease the boarding may recover the outcomes for Emergency
Department patients who are admitted to the healthcare facility as per the research article.
How are specific findings presented?
The specific findings that are provided in the paper are presented in the form of specific
tables, graphs and figures.
Does the writing effectively promote understanding?

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The language used in this particular paper is not that complex and a flow is maintained in
the paper along with the proper illustration of the results.
The degree of results which I can use to treat my patients?
The results of this study will be helpful in future since it helps to identify the patient
problems and in turn increase the quality of care. The results that are obtained from the study are
able to reduce the negative impact of e boarding that might improve the consequences for the
patients of ED admitted within the healthcare facility (Sun et al., 2013).
Are the results relevant to persons in similar situations?
The obtained results were not applicable for all since was only a retrospective review of a
large database which was developed in a computerized manner. Hence from this it was only
possible to estimate the associations that exists between the variable predictors and the outcomes.
Can we apply the results depending on its patient value as well as circumstances?
The obtained results was able to show that with the increase in the Emergency boarding
there was also an increase in the negative outcomes on the patients which resulted in the
adjustment for comorbid conditions and other factors. As a result of this, there was a possibility
of only determining the casualty through a potential clinical experimental trial in which patients
that are admitted are randomized to lengthy ED boarding or instant transfer to an inpatient bed
(Qiu et al., 2015).

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How can we apply the results in the process of clinical practice?
The result that is obtained from the above study can be applied in terms of clinical
practice since the Emergency department or the ED boarding has been related to numerous
negative patient concerned with consequences, from poorer gratification to higher inpatient
mortality rates. Since this study appraises the connotation that is present between the length of
boarding within the emergency department and outcomes (Singer et al., 2013).