Inpatient Boarding in the ED and Clinical Outcomes
Yousufuddin et al., American Journal of Emergency Medicine, September 23, 2025
📌 Conclusions
-
ED boarding does not increase LOS or in-hospital mortality.
-
But: Boarding is associated with a 30% increase in 90-day mortality.
-
Suggests that delayed inpatient transition may have longer-term downstream effects not captured during the index hospitalization.
👨⚕️ Clinical Implications for Emergency Physicians
-
Immediate safety: No signal of increased in-hospital death or prolonged LOS.
-
Hidden risk: Elevated 90-day mortality signals possible downstream care delays, missed interventions, or complications after discharge.
-
System-level message: Boarding remains a patient safety concern beyond the ED stay—even short boarding times (median ~4 h) carried risk.
-
Reinforces the need for hospital throughput improvements and policy efforts to reduce ED boarding.
🧪 Methods
-
Design: Retrospective, propensity-matched cohort study
-
Setting: 22 EDs, 17 hospitals in Southeast Minnesota
-
Period: April 2019 – March 2024
-
Population: 151,834 ED admissions; 3173 (1.9%) were classified as boarders
-
Median boarding time: 4.2 hours (IQR 1.8–9.7)
-
Matching: 86 covariates controlled
-
Outcomes:
-
Primary: Hospital length of stay (LOS), in-hospital mortality
-
Secondary: All-cause 90-day mortality
📊 Results
-
In-hospital mortality: No difference (OR 0.84, 95% CI 0.59–1.20; p = 0.34)
-
Hospital LOS: No significant increase (IRR 1.02, 95% CI 0.99–1.04; p = 0.088)
-
90-day mortality: Higher among boarders (HR 1.30, 95% CI 1.15–1.46; p = 0.005)
-
Findings were consistent across age, sex, and ED location.
Yousufuddin, M., Leopold, K., Napoli, A.M., Ma, Z., Barkoudah, E., Wang, Z., Khandelwal, K., Pagali, S., Issa, M., Tahir, M.W. and Bhagra, S., 2025. Inpatient boarding in the emergency departments and clinical outcomes: A propensity-matched study. The American Journal of Emergency Medicine.