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
Agustín Fernández-Cisnal1, Òscar Miró2, Carla Boixeda2, Christian Luis Di Paolo2, Carolina Rangel2, Luisa F. Villate Robles3, Laura Fernández Gutiérrez3, Ernest Bragulat2
Objective.
To evaluate the association between overnight boarding in the emergency department after the decision to admit and in-hospital mortality and total episode duration among older patients admitted through the emergency department of a minimally overcrowded hospital in Boston (Massachusetts, United States).
Methods.
A retrospective cohort study was conducted using MIMIC-IV data from 2011 through 2019. Patients aged 65 years or older who were admitted through the emergency department and had a documented admission order were included; patients admitted to intensive care were excluded. Overnight boarding was defined as remaining in the emergency department until 8:00 AM, whereas controls were defined as patients who left the emergency department before midnight. Five sensitivity analyses were performed, with adjustment for age, sex, and comorbidity.
Results.
A total of 2,806 patients were included: 2,471 controls and 335 patients who experienced overnight boarding. Although time to the admission decision did not differ between groups, the wait for an inpatient bed was substantially longer among patients who experienced overnight boarding (1.2 vs 20.1 hours). The in-hospital mortality rate was 2.0% (49/2,471) in the control group and 2.4% (8/335) in the overnight-boarding group, with an adjusted OR of 1.21 (95% CI, 0.56-2.60). Moreover, total episode duration was similar between the groups (+0.21 days; 95% CI, −0.14 to 0.57). Sensitivity analyses yielded consistent findings for mortality, with ORs of 1.31, 1.27, and 1.64, and showed a longer episode duration only in the medical cohort (+0.61 days). When a documented admission order was not required, the OR was 0.68 (95% CI, 0.48-0.97). Age did not modify the results.
Conclusions.
In this selected low-risk cohort, overnight boarding was not associated with in-hospital mortality or total episode duration. However, the small number of events and the potential for selection bias preclude ruling out a harmful effect.
