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National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency?

Published online by Cambridge University Press:  01 March 2016

Jennifer S. Love Open the ORCID record for Jennifer S. Love [Opens in a new window] ,
David Karp ,
M. Kit Delgado ,
Gregg Margolis ,
Douglas J. Wiebe  and
Brendan G. Carr
Jennifer S. Love*
Affiliation:
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
David Karp
Affiliation:
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
M. Kit Delgado
Affiliation:
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
Gregg Margolis
Affiliation:
Office of the Assistant Secretary of Preparedness and Response, US Department of Health and Human Services, Washington, DC
Douglas J. Wiebe
Affiliation:
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
Brendan G. Carr
Affiliation:
Office of the Assistant Secretary of Preparedness and Response, US Department of Health and Human Services, Washington, DC Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
*
Correspondence and reprint requests to Jennifer S. Love, MD, Department of Emergency Medicine, University of Pennsylvania, 3400 Spruce Street, Ground Floor, Ravdin Bldg, Philadelphia, PA 19104 (e-mail: jennifer.love2@uphs.upenn.edu).
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Abstract

Objectives

Boarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies.

Methods

A retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering.

Results

A total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times.

Conclusions

Urban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576–582)

Keywords

disaster planningemergency preparednesshealth servicesdisaster medicineboarding time
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Issue 4 , August 2016 , pp. 576 - 582
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2016 

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