The impact of inpatient boarding on ED efficiency: a discrete-event simulation study

J Med Syst. 2010 Oct;34(5):919-29. doi: 10.1007/s10916-009-9307-4. Epub 2009 May 15.


In this study, a discrete-event simulation approach was used to model Emergency Department's (ED) patient flow to investigate the effect of inpatient boarding on the ED efficiency in terms of the National Emergency Department Crowding Scale (NEDOCS) score and the rate of patients who leave without being seen (LWBS). The decision variable in this model was the boarder-released-ratio defined as the ratio of admitted patients whose boarding time is zero to all admitted patients. Our analysis shows that the Overcrowded(+) (a NEDOCS score over 100) ratio decreased from 88.4% to 50.4%, and the rate of LWBS patients decreased from 10.8% to 8.4% when the boarder-released-ratio changed from 0% to 100%. These results show that inpatient boarding significantly impacts both the NEDOCS score and the rate of LWBS patient and this analysis provides a quantification of the impact of boarding on emergency department patient crowding.

MeSH terms

  • Adult
  • Appointments and Schedules
  • California
  • Child
  • Crowding*
  • Decision Support Techniques*
  • Efficiency, Organizational*
  • Forecasting
  • Health Services Accessibility
  • Humans
  • Outcome and Process Assessment, Health Care*
  • Patient Admission* / statistics & numerical data
  • Patient Dropouts / statistics & numerical data
  • Regression Analysis
  • Trauma Centers / organization & administration*