Bottom Line: Among hospitalized patients boarding in the emergency department, care at an academic safety-net hospital, overnight admission, and elevated lactate levels may be independent predictors of early clinical deterioration.
Additional Information
Emergency department (ED) boarding of admitted patients remains a major public health and patient safety challenge, particularly since the COVID-19 pandemic. In this retrospective observational study, the authors evaluated the incidence of early clinical deterioration among adult patients admitted to an inpatient service while boarding in the ED, defined as escalation from floor to intermediate or intensive care within 48 hours of the admission order. From January 2018 through June 2024, 173,168 encounters were analyzed. Overall, 3.6% of patients experienced early clinical deterioration, and 45% of these events occurred while patients were still boarding in the ED. Independent predictors of deterioration included care at an academic safety-net hospital, overnight admission, and elevated lactate levels.
References
Rizer NW, Klein E, Copenhaver MS, Zhao X, Kelen GD, Hinson JS. Early clinical deterioration among emergency department boarders: a retrospective analysis. Ann Emerg Med. 2026;87(6):681-693. Doi: 10.1016/j.annemergmed.2026.01.023