[INCREASED MORTALITY OF DELAYED PATIENTS IN THE EMERGENCY DEPARTMENT OF A TERTIARY MEDICAL CENTER].

Introduction: Boarding patients awaiting hospitalization in the emergency department increases mortality and complications, and stands in contrast to the recommendations of emergency medicine associations worldwide. Although Israel's Ministry of Health and the media are addressing the issue, boarding patients in emergency departments is common in hospitals throughout the country. There are no current studies that assess the influence of boarding in emergency departments on the patient's mortality and hospitalization. In 2011, a decision was made in our hospital to board patients in a separate section of the emergency department due to the lack of beds in the inpatient wards.

Aims: This study aimed to demonstrate the scale of boarding patients in a tertiary hospital in Israel and its influence on mortality and length of hospitalization. We examine effects of a deliberate boarding policy on mortality and describe the boarding phenomena, and its causes, to Israeli physicians.

Study Methods: This is a retrospective study, comparing patients hospitalized through the emergency department to internal medicine wards in a tertiary hospital during three consecutive years, and studying the effects of deliberate boarding policy in the emergency department on mortality and length of stay [LOS] in the hospital.

Results: Roughly half the patients stayed in the emergency department for more than 10 hours. The mortality of patients during the year they were deliberately boarded in a separate section in the emergency department was significantly higher than in other years, when such policy did not take place. A direct link was demonstrated between LOS in the emergency department and mortality. LOS of patients who died was significantly higher than that of patients who did not die.

Conclusions: Boarding patients in the emergency department increases mortality and LOS. Ways to minimize the phenomena should be explored.

Discussion: For the first time, the effects of boarding patients in the emergency department in Israel are studied. The issue of boarding patients in emergency departments should be a central issue addressed by Israel's health system.