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Association of emergency department boarding times on hospital length of stay for patients with psychiatric illness
  1. Daniel J Lane1,
  2. Lauren Roberts2,
  3. Shawn Currie3,
  4. Rachel Grimminck1,4,
  5. Eddy Lang1,5
  1. 1University of Calgary, Calgary, Alberta, Canada
  2. 2Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  3. 3Addiction and Mental Health Services, Alberta Health Services, Calgary, Alberta, Canada
  4. 4Psychiatry, Alberta Health Services, Calgary, Alberta, Canada
  5. 5Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Daniel J Lane, University of Calgary, Calgary, AB T2N 1N4, Canada; dan.lane{at}


Background Extended periods awaiting an inpatient bed in the emergency department (ED) may exacerbate the state of patients with acute psychiatric illness, increasing the time it takes to stabilise their acute problem in hospital. Therefore, we assessed the association between boarding time and hospital length of stay for psychiatric patients.

Methods ED clinical records were linked to inpatient administrative records for all patients with a primary psychiatric diagnosis admitted to a Calgary, Alberta hospital between April 2014 and March 2018. The primary exposure was boarding time (admission decision to inpatient bed transfer), and primary outcome was inpatient length of stay. Confounders for this relationship, including indicators of illness severity, were selected a priori then the association was assessed using hierarchical Bayesian Poisson regression, which accounts for repeat observations of the same patient and differences between hospital sites. Changes in length of stay were measured using a rate ratio (ie, expected change in length of stay for each 1 hour increase in boarding time).

Results A total of 19 212 admissions (14 261 unique patients) were included in the analysis. The average boarding time was 14 hours (range: 0–186 hours). Patients who were boarded for greater than 14 hours more frequently required a high-observation bed (14% vs 3.5%), received an antipsychotic (44% vs 14%) or received sedation (55% vs 33%) while in the ED. The probability that boarding time increased hospital length of stay (rate ratio: >1) was 92%, with a median increase for a patient boarded for 24 hours of 0.01 days.

Conclusion Boarding in the ED was associated with a high probability of increasing the hospital length of stay for psychiatric patients; however, the absolute increase is minimal. Although slight, this signal for longer length of stay may be a sign of increased morbidity for psychiatric patients held in the ED.

  • emergency department
  • psychological conditions
  • emergency department operations

Data availability statement

Data may be obtained from a third party and are not publicly available. The data used in this study were accessed through Alberta Health Services.

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Data availability statement

Data may be obtained from a third party and are not publicly available. The data used in this study were accessed through Alberta Health Services.

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  • Handling editor Loren De Freitas

  • Twitter @DanLane911, @EddyLang1

  • Contributors LR and EL conceived of this study, obtained data and helped with study design. RG and SC helped design the study and interpret the results. DL conducted the analysis and wrote the primary manuscript. All authors contributed to substantial revisions of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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