Browsing by Author "Fahmy, Sami"

Introduction: When the decision of admitting a patient into an inpatient ward has been made but the patient remains waiting in the emergency department, the term boarding is used to describe this phenomenon. Boarding is associated with higher mortality, prolonged length of stay and increased hospital expenditure. The objective of this study is to examine the patient transfer conventions used for adult, non-ICU-bound ED patients and to uncover specific targetable causes of patient boarding. The study hospital emergency department treats internal medicine, neurological and surgical adult patients. The information provided by this study is to be used to improve the study hospital’s practices. Methods: The methods for this study were both qualitative and quantitative. The study was conducted in June and July of 2018 by directly observing the practices of the study ED and by measuring the time used for completing the steps relating to patient transfer to inpatient wards from the emergency department. The perceived reasons for delays during the transfer process were observed and logged. Results: The study hospital uses a patient transfer system where nurses communicate directly with each other. Patients could be moved to the wards only after a ward nurse approved it. The observed mean duration of the entire patient transfer process was 106 minutes. Most of this time was spent waiting for the go-ahead to transfer the patient and the mean for time for this part of the transfer process was 64 minutes. Nurses from the inpatient wards did not usually specify the exact cause for delays from their side. Discussion: Some limitations of this study included the small sample size and the fact that the operation of the ED was mostly observed during office hours on weekdays. Most of the boarding time consisted of waiting for the ward’s go-ahead to bring a patient in. To alleviate the problem of boarding in the study hospital, we think that giving the ED nurses a more active role in the admitting process is a key solution. Communication between the ED and the wards should also be improved.