Objectives: The median emergency department (ED) boarding time for admitted patients has been a nationally reportable core measure that now also affects ED accreditation and reimbursement. However, no direct national probability samples of ED boarding data have been available to guide this policy until now. The authors studied new National Hospital Ambulatory Medical Care Survey (NHAMCS) survey items to establish baseline values, to generate hypotheses for future research, and to help improve survey quality in the future.
Methods: This was a cross-sectional, multistage, stratified annual analysis of EDs and ED visits from the National Hospital Ambulatory Medical Care Survey public use files from 2007 to 2010, a total of 139,502 visit records. These data represent the only national measure of ED boarding. The main outcome of interest was boarding duration for individual patient visits. Data analyses accounted for complex sampling design.
Results: The national median boarding time was 79 minutes, with an interquartile range of 36 to 145 minutes. The prevalence of boarding for more than 2 hours among admitted patients was 32% (95% confidence interval [CI] = 30% to 35%). Average ED volume, occupancy, acuity, and hospital admission rates increased abruptly from the second to the third quartile of median boarding duration. The half of hospitals with the longest median boarding times accounted for 73% of ED visits and 79% of ED hospitalizations nationally. Thirty-nine percent of EDs (95% CI = 32% to 46%) reported never holding patients for more than 2 hours, but visit-level analysis at these EDs found that 21% of admissions did in fact stay in the ED over 2 hours. Only 19% of EDs (95% CI = 16% to 22%) used a strategy of moving admitted patients to alternative sites in the hospital during crowded times.
Conclusions: In this national survey, ED boarding of admitted patients disproportionately affects hospitals with higher ED volumes, which also see sicker patients who wait longer to be seen, but not hospitals with higher proportions of Medicaid or uninsured visits. This finding implies that, unlike other quality measures, there is a negative volume-outcome relationship for timely hospitalization from the ED.
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http://dx.doi.org/10.1111/acem.12375 | DOI Listing |
Cureus
December 2024
Orthopaedics and Traumatology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, TUR.
Aneurysmal bone cysts (ABCs) are aggressive, osteolytic lesions usually seen in childhood and young adulthood. The patient's age, location, and behavior of the lesion in the bone may cause patients to present with different clinical findings. Appropriate treatment of these rare, aggressive bone lesions is essential for recurrence.
View Article and Find Full Text PDFCureus
December 2024
Internal Medicine, Hospital Beatriz Ângelo, Lisboa, PRT.
Vitamin B12 deficiency is a potentially severe condition with clinical manifestations ranging from nonspecific symptoms, such as asthenia and glossitis, to severe hematological problems, including pancytopenia and megaloblastic anemia. One of the rare phenomena associated with this condition is pseudo-thrombotic microangiopathy (pseudo-TMA), which can mimic diseases such as thrombotic thrombocytopenic purpura (TTP), leading to possible misdiagnosis and inappropriate treatment. In this article, we present the case of a 62-year-old man with a history of intravenous drug use, untreated hepatitis C, smoking, and alcoholism.
View Article and Find Full Text PDFFront Public Health
January 2025
Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China.
Background: Periviable infants are a highly vulnerable neonatal group, and their survival rates are considerably affected by patient-, caregiver-, and institution-level factors, exhibiting wide variability across different income countries and time periods. This study aims to systematically review the literature on the survival rates of periviable infants and compare rates among countries with varied income levels and across different time periods.
Methods: Comprehensive searches were conducted across MEDLINE, Embase, CENTRAL, and Web of Science.
Radiol Case Rep
March 2025
Faculty of Medicine, Arab American University of Palestine, Jenin, Palestine.
Spontaneous cervical swelling syndrome is an uncommon clinical syndrome characterized by the sudden onset of swelling in the cervical region with no identifiable cause. A 47-year-old woman with a history of Iron Deficiency Anemia presented to the emergency department (ED) complaining of an acute left neck and upper chest swelling and pressure sensation in her neck. The swelling started suddenly and was growing rapidly over several hours.
View Article and Find Full Text PDFJMIR Hum Factors
January 2025
Department of Medical Safety, Shizuoka General Hospital, Shizuoka, Japan.
Background: Falls in hospitalized patients are a serious problem, resulting in physical injury, secondary complications, impaired activities of daily living, prolonged hospital stays, and increased medical costs. Establishing a fall prediction scoring system to identify patients most likely to fall can help prevent falls among hospitalized patients.
Objectives: This study aimed to identify predictive factors of falls in acute care hospital patients, develop a scoring system, and evaluate its validity.
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