(1612) Impact of Boarding Time Mortality in Cancer Patients Presenting to Emergency Department With Fever

Introduction: Cancer patients with fever frequently visit our Emergency Department (ED). Knowing these visits may indicate a serious issue, including sepsis, septic shock, treatment-related complication, or disease progression, prompt management is critical. Extended boarding times in emergency centers are linked to higher morbidity and mortality rates, thus understanding the effect of boarding time on mortality for oncology patients with fever is important. In this study, we examined the association between boarding times and short-term mortality in patients presenting to an oncologic ED.

Methods: We conducted a retrospective study for all consecutive ED visits to our comprehensive cancer center ED known as the Acute Cancer Care Center (ACCC) between March 2020 and December 2022 for patients 19 years and older who were admitted to an inpatient unit. We defined boarding time as the period from when the physician issued the order for hospital admission to the patient's departure from the ED. Patient characteristics were examined using descriptive statistics. Univariate and multivariable logistic regression analyses were used to examine the association between boarding time and 30-day mortality reporting the odds ratio (OR) and its 95% confidence interval (95% CI).

Results: During the study period, there were 4744 ED visits for 3523 unique patients. The median age at the first visit was 61 years (interquartile range=49-70 years). The majority of the patients were male (54.3%), White or Caucasian race (72.1%) and Not Hispanic or Latino ethnicity (79.8%). The median ED boarding was 2.1 hours (interquartile range: 1.3–3.7 hours) and 30-day mortality was 5.4% (n=257). In the univariate analysis, boarding time (in hours) was significantly associated with 30-day mortality (OR=1.04; 95% CI=1.00-1.08; P=0.034). Similar results were observed in the multivariable analysis when controlling for age, sex, race and Charlson comorbidity index (OR=1.04; 95% CI=1.00-1.08; P=0.042).

Conclusions: In cancer patients presenting to the ED/ACCC with fever, longer boarding times are associated with higher short-term mortality. These results highlight the necessity for enhanced strategies to accelerate the admission process as part of the proper critical care management for these patients.