• Jian-Cang Zhou, Kong-Han Pan, Dao-Yang Zhou, San-Wei Zheng, Jian-Qing Zhu, Qiu-Ping Xu, and Chang-Liang Wang.
• Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
• Am. J. Med. 2012 Apr 1;125(4):416.e1-7.

BackgroundBoarding admitted patients in the emergency department due to high hospital occupancy is a worldwide problem. However, whether or not emergency department-boarded patients managed by emergency department providers subjects them to increased serious complications needs further clarification.MethodsA multivariate logistic regression analysis was used to examine the relationship of patient's age, sex, arrival hours, diagnostic category, triage category, daily emergency department visits, and daily hospital occupancy to the occurrence of serious complications within 24 hours for 20,276 emergency admissions in a 4-year period.ResultsA vast majority of study days (86.5%) saw very high occupancy ≥90%. Serious complications incidence was 13.62 per 1000 patient days when hospital occupancy was ≤90%, and it increased significantly to 17.10 and 22.52 per 1000 patient days for occupancy at 90%-95% and ≥95%, respectively. In the multivariate analysis, significant risk factors for serious complications included daily occupancy ≥95% (adjusted odds ratio [OR] 1.73; 95% confidence interval [CI], 1.26-2.39), triage category (adjusted OR 0.20; 95% CI, 0.17-0.24), and specific diagnoses (injury and poisoning [adjusted OR 1.62; 95% CI, 1.22-2.84], respiratory [adjusted OR 2.48; 95% CI, 1.37-4.49], and circulatory [adjusted OR 3.24; 95% CI, 1.80-5.80]).ConclusionHigh hospital occupancy was associated with an increased incidence of serious complications within 24 hours for patients admitted but still boarded in the emergency department and managed by emergency department providers.Copyright © 2012 Elsevier Inc. All rights reserved.

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