(419) Outcomes of Boarding Critically Ill Patients in U.S. EDs: A Systematic Review and Meta-Analysis

Introduction: Boarding is the practice of holding patients in the emergency department (ED) or a temporary location after the decision to admit or transfer has been made. Previous literature suggested that ED Length of Stay (LOS), which is prolonged in boarded patients, has been linked to worse outcomes. We conducted a systematic review and meta-analysis (SR/MA) to evaluate the differences in mortality and hospital length of stay (LOS) in ED-boarding (EDB) and non-ED boarding (non-EDB) critically ill patients in U.S. EDs.

Methods: We searched the following databases: PubMed (including MEDLINE), Embase (via Elsevier), CINAHL (via EBSCO), and Clarivate Web of Science, including the following indexes: Web of Science Core Collection, Biosis, Current Contents Connect, Data Citation Index, and Medline, from inception through December 2023. Any observational or randomized studies involving adult patients that compared an EDB group and a non-EDB group were eligible. Only full-text articles in English language and studies involving U.S. EDs were included. Outcomes were any reported mortality and hospital LOS. We used random-effects meta-analysis to compare the outcomes. Heterogeneity between studies was assessed with the I2 value while publication bias was assessed via the funnel plot.

Results: We identified 2056 studies and included 19. Overall, 408,127 ED patients were included: 194,913 (48%) EDB and 213,214 (52%) non-EDB. Median ED LOS for the EDB and the non-EDB groups were 6 hours (Interquartile Range [IQR] 2-7) and 3.4 hours (IQR 1.8-6), respectively (p=0.019). EDB patients had similar all-cause mortality rates (OR 1.04, 95% CI 0.92-1.16, I2=68%) and similar hospital LOS (mean difference 0.37 days, 95% CI -1.23 to 0.65, I2=54%). The funnel plot suggested the presence of publication bias favoring lower mortality in non-EDB group. There was also high heterogeneity and inconsistency regarding the definition of boarding time and how to report outcomes among the included studies.

Conclusions: Our SR/MA suggested that EDB group was associated with similar mortality rates and hospital LOS as compared to the non-EDB group.