A Pilot Study Examining Undesirable Events Among Emergency Department–Boarded Patients Awaiting Inpatient Beds
Presented as a poster at the Society for Academic Emergency Medicine annual meeting, April 2005, Boston, MA.
Received 16 August 2008; received in revised form 5 January 2009 and 28 January 2009; accepted 2 February 2009. published online 23 March 2009.
Study objective
We describe the frequency of undesirable events among patients boarding at a single, urban, tertiary, teaching emergency department (ED) through retrospective chart abstraction.
Methods
This was a chart review of all patients admitted during 3 randomly selected days in 2003 (n=162) to track the frequency of undesirable events such as missed relevant home medications, missed laboratory test results, arrhythmias, or other adverse events.
Results
One hundred fifty-one charts were abstracted (93.2%); 27.8% had an undesirable event, 17.9% missed a relevant home medication, and 3.3% had a preventable adverse event. There was a higher frequency of undesirable events among older patients (35.9%, aged >50 years; 7.3%, aged 20 to 49 years; 28.6%, aged 0 to 19 years) and those with more comorbidities (44.4% among Charlson score ≥3; 30.8% score 2; 36.1% score 1; 14.5% score 0).
Conclusion
A substantial frequency of undesirable events occurs while patients board in the ED. These events are more frequent in older patients or those with more comorbidities. Future studies need to compare the rates of undesirable events among patients boarding in the ED versus inpatient units.
aDepartment of Surgery, Harvard Medical School, Boston, MA
bDepartment of Medicine, Harvard Medical School, Boston, MA
cDepartment of Emergency Services, Massachusetts General Hospital, Boston, MA
dDivision of Emergency Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
eDepartment of Family and Community Medicine, University of Massachusetts, Boston, MA
Address for correspondence: Shan Liu, MD, MPH, Massachusetts General Hospital, Department of Emergency Medicine, 55 Fruit Street, Zero Emerson, Room 358, Boston, MA 02114; 617-726-4809, fax 617-724-0917
Supervising editor: Robert L. Wears, MD, MS
Author contributions: SWL, JAG, and JSW conceived the study and designed the study. SWL performed initial chart abstraction. SHT and AGH performed secondary implicit chart review. SWL managed the data. SHT provided statistical advice. SWL drafted the article, and all authors contributed substantially to its revision. SWL takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
Publication date: Available online March 13, 2009.
ABSTRACT