Patients Prefer Inpatient Boarding to ED Boarding
We performed a structured telephone survey of a 110 consecutive patients admitted to our medical center from January 1, 2008 who had been boarded in an ED hallway followed by an inpatient hallway before being transferred to a standard inpatient bed. The study was approved by the Institutional Review Board before inception and all patients gave verbal informed consent over the telephone.
Our medical center is a level 1, suburban, university-based teaching hospital with an annual ED volume of approximately 75,000 adult patients and a 22% admission rate. An FCP has been in place at our institution since 2001. The policy is implemented when the ED is full and admitted patients are awaiting in-house placement to acute care units. Patients with minimal to moderate risk factor comorbidity will be considered for hallway bed placement first, and this includes patients requiring cardiac telemetry. Patients are excluded from the FCP if they: require intermediate care unit or intensive care unit, are ventilated, require negative-pressure room, require ≥4 L supplemental oxygen, require suctioning, or have diarrhea or are incontinent of stool. All ED patients that required admission were screened for eligibility. These patients were identified by the emergency physician when the admission order was placed. Inclusion criteria for the study required boarding in the ED hallway after hospital admission, followed by inpatient hallway boarding before placement in a standard inpatient room. Patients were notified that their answers would be kept anonymous. The survey was conducted within several months of their hospital discharge.
We developed and pilot tested a structured survey designed to measure satisfaction with boarding in acute care units vs. the ED. The survey instrument was based on a literature review of ED crowding. After pilot testing, the survey was revised based on feedback. Piloting of the survey was done with 10 patients in the ED and on the inpatient floor. Questions were added and omitted to the survey after consulting with boarded patients. The final survey tool was than piloted with an additional 10 patients before being used in the study.
Patients were identified on the telephone by one of the investigators, consented, and surveyed using a structured interview. Collected data included basic demographic information. Participants were then asked the following questions:
We then asked patients to compare their stays in the ED hallway vs. the inpatient hallway. Patients were asked to rate their location preference with regard to the following aspects of care, based on their personal experience with both ED and acute care unit hallway boarding: ability to sleep or rest, level of safety, level of confidentiality, level of noise, availability of hospital staff (physicians, nurses, nursing assistants, and clerks), and level of privacy. Answers for each of the items were provided on a 5-point Likert scale consisting of the following answers: ED hallway much better, ED hallway better, no preference, inpatient hallway better, and inpatient hallway much better.
Standard descriptive statistics are reported, and Stata 9 (StataCorp, College Station, TX) was used to calculate 95% confidence intervals (CIs). In determining patient boarding-location preferences, ED preference for each individual item was calculated by combining the percentages of patients who answered "ED hallway much better" or "ED hallway better."
Methods
Study Design
We performed a structured telephone survey of a 110 consecutive patients admitted to our medical center from January 1, 2008 who had been boarded in an ED hallway followed by an inpatient hallway before being transferred to a standard inpatient bed. The study was approved by the Institutional Review Board before inception and all patients gave verbal informed consent over the telephone.
Setting and Selection of Participants
Our medical center is a level 1, suburban, university-based teaching hospital with an annual ED volume of approximately 75,000 adult patients and a 22% admission rate. An FCP has been in place at our institution since 2001. The policy is implemented when the ED is full and admitted patients are awaiting in-house placement to acute care units. Patients with minimal to moderate risk factor comorbidity will be considered for hallway bed placement first, and this includes patients requiring cardiac telemetry. Patients are excluded from the FCP if they: require intermediate care unit or intensive care unit, are ventilated, require negative-pressure room, require ≥4 L supplemental oxygen, require suctioning, or have diarrhea or are incontinent of stool. All ED patients that required admission were screened for eligibility. These patients were identified by the emergency physician when the admission order was placed. Inclusion criteria for the study required boarding in the ED hallway after hospital admission, followed by inpatient hallway boarding before placement in a standard inpatient room. Patients were notified that their answers would be kept anonymous. The survey was conducted within several months of their hospital discharge.
Survey Instrument
We developed and pilot tested a structured survey designed to measure satisfaction with boarding in acute care units vs. the ED. The survey instrument was based on a literature review of ED crowding. After pilot testing, the survey was revised based on feedback. Piloting of the survey was done with 10 patients in the ED and on the inpatient floor. Questions were added and omitted to the survey after consulting with boarded patients. The final survey tool was than piloted with an additional 10 patients before being used in the study.
Data Collection and Processing
Patients were identified on the telephone by one of the investigators, consented, and surveyed using a structured interview. Collected data included basic demographic information. Participants were then asked the following questions:
What, if any, concerns did you have in the ED hallway?
What, if any, concerns did you have in the inpatient hallway?
If you came to the ED, do you think that it is alright to move another patient out of a room and into the hallway so that you can be seen quicker?
Would it be alright to move you out of your room into the hallway in order to see another patient quicker?
We then asked patients to compare their stays in the ED hallway vs. the inpatient hallway. Patients were asked to rate their location preference with regard to the following aspects of care, based on their personal experience with both ED and acute care unit hallway boarding: ability to sleep or rest, level of safety, level of confidentiality, level of noise, availability of hospital staff (physicians, nurses, nursing assistants, and clerks), and level of privacy. Answers for each of the items were provided on a 5-point Likert scale consisting of the following answers: ED hallway much better, ED hallway better, no preference, inpatient hallway better, and inpatient hallway much better.
Data Analysis
Standard descriptive statistics are reported, and Stata 9 (StataCorp, College Station, TX) was used to calculate 95% confidence intervals (CIs). In determining patient boarding-location preferences, ED preference for each individual item was calculated by combining the percentages of patients who answered "ED hallway much better" or "ED hallway better."
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