Another major problem for EDs has been "boarding" which refers to patients waiting for an ED bed assignment. This is an all-too-frequent phenomenon that is often seen as a culprit in ED occupancy and duration of stay. Hospital officials have been working to relieve the pressure on boarding for years, which has often resulted in ambulances diverted, and critically ill patients traveling farther for care, adding delays to their treatment.
"That was the second surprise," Pines said.
While boarding practices are certainly factors in crowding, they contribute significantly less than "practice intensity," which again includes "more frequent blood testing, greater use of advanced imaging and more frequent administration of intravenous fluids," the study states.
"We hypothesized that increased boarding of hospital admissions in the ED would be the most important cause of increasing levels" of occupancy in the ED, the report states. "This was not the case."
"We found that boarding is important and a big contributor," Pines says. "If you looked particularly at the difference why length of stay was increasing over the eight-year period, it looked like it wasn't boarding going up, it was more practice intensity, taking the lab tests or blood tests. "