Emergency Department’ Overcrowding and Outcomes: The Impact of Boarding Time Efficiency and Patient Flow in a Tertiary Referral Hospital

Background. Long stays for patients awaiting admission congest the emergency department and disrupt most processes. This study aimed to evaluate the length of stay for patients waiting for admission after assignment in the emergency department of Imam Reza Hospital, the provincial referral center, and its relationship with the short-term outcome of patients in the emergency department (ED). Methods. In a cross-sectional descriptive study, 400 boarding patients in the ED of Imam Reza Hospital were evaluated during July-December 2024. The study variables included the type of disease and initial diagnosis, the required admission hospital ward, the outcome of patients in the ED, and the timeliness indicators of patient attendance in the ED. Patients were followed up until they left the ED. Data were analyzed using Kruskal-Wallis tests and Spearman correlation. Results. Out of the patients, 312 (78%) were classified as triage level two. The disease type of 335 patients (83.8%) was internal diseases, and the most common initial diagnosis was respiratory failure (24% of all patients). Also, five patients (1.3%) died in the ED during the study. The mean times from admission to assignment, assignment to discharge from the ward, and length of stay of the patient in the ED were 5:37±7:39, 14:23±17:27, and 14:54±24:49 (hours: minutes), respectively. There was no statistically significant relationship between the number of ED visits per day and patient outcomes in the ED with time indicators (P-value =0.095). There was a statistically significant relationship between the bed-day occupancy rate in the hospital wards, the type of disease, and the required inpatient ward, and with time indicators with P-values of 0.001, <0.001, and <0.001, respectively. Conclusion. The number of cases waiting for admission to the ED was higher among the patients in the internal disease group. Therefore, necessary measures should be taken to control ED overcrowding by quickly releasing boarding patients and reducing the number of cases waiting for hospitalization in the ED. In future studies, it is necessary to evaluate the cost incurred by the hospital due to the stay of these patients in the ED, the workload imposed on the ED medical staff, and the follow-up of the outcome of boarding patients in the emergency department.