Do admitted patients held in the emergency department impact the throughput of treat-and-release patients?

Acad Emerg Med. 1996 Dec;3(12):1113-8. doi: 10.1111/j.1553-2712.1996.tb03370.x.


Objective: To examine the impact of reducing ED "boarders" (through the use of a short-stay inpatient medicine unit) on the amount of time that treat-and-release patients spend in the ED.

Methods: A retrospective analysis of hours spent in the ED was made at a university hospital teaching ED for treat-and-release patients in 4 clinical categories: chest pain, asthma exacerbation, sickle-cell crisis, and seizure. The average hours per patient spent in the ED during the 4-month intervals before (August-November 1993) and after (August-November 1994) the establishment of the short-stay medicine unit were compared. Data were analyzed using the 2-tailed, unpaired t-test.

Results: This short-stay inpatient medicine unit received on average 135 patients per month from the ED, with an average length of stay of 2.4 days. The mean (+/-SD) number of admitted patients per day waiting in the ED > 8 hours for an inpatient bed dropped from 9.6 +/- 4.2., before the institution of this unit, to 2.3 +/- 2.6. There was a significant reduction in the average number of hours spent in the ED by treat-and-release patients with chest pain (from 7.3 +/- 6.0 to 5.5 +/- 4.8 hr/patient, p < 0.001) and asthma exacerbation (from 5.0 +/- 3.6 to 4.2 +/- 2.9 hr/patient, p < 0.05), but not with sickle-cell crisis or seizure, after the implementation of the short-stay unit.

Conclusion: Reducing the number of admitted patients waiting in the ED for inpatients beds, in this case by establishment of a short-stay medicine unit, is associated with a decrease in the interval that treat-and-release patients spend in the ED.

MeSH terms

  • Adult
  • Anemia, Sickle Cell / therapy
  • Asthma / therapy
  • Chest Pain / therapy
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data*
  • Health Services Research
  • Hospital Bed Capacity, 500 and over
  • Hospital Units / organization & administration
  • Hospital Units / statistics & numerical data*
  • Hospitals, Teaching
  • Humans
  • New York
  • Patient Admission / standards*
  • Retrospective Studies
  • Seizures / therapy
  • Time Factors
  • Time Management
  • Waiting Lists*