Effect of a Boarding Restriction Protocol on Emergency Department Crowding

Ji Hwan Lee, Ji Hoon Kim, Incheol Park, Hyun Sim Lee, Joon Min Park, Sung Phil Chung, Hyeon Chang Kim, Won Jeong Son, Yun Ho Roh, Min Joung Kim

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Purpose: Access block due to the lack of hospital beds causes crowding of emergency departments (ED). We initiated the “boarding restriction protocol” that limits the time of stay in the ED for patients awaiting hospitalization to 24 hours from arrival. The purpose of this study was to determine the effect of the boarding restriction protocol on ED crowding. Materials and Methods: The primary outcome was ED occupancy rate, which was calculated as the ratio of the number of occupying patients to the total number of ED beds. Time factors, such as length of stay (LOS), treatment time, and boarding time, were investigated. Results: The mean of the ED occupancy rate decreased from 1.532±0.432 prior to implementation of the protocol to 1.273±0.353 after (p<0.001). According to time series analysis, the absolute effect caused by the protocol was-0.189 (-0.277 to-0.110) (p=0.001). The proportion of patients with LOS exceeding 24 hours decreased from 7.6% to 4.0% (p<0.001). Among admitted patients, ED LOS decreased from 770.7 (421.4–1587.1) minutes to 630.2 (398.0–1156.8) minutes (p<0.001); treatment time increased from 319.6 (198.5–482.8) minutes to 344.7 (213.4–519.5) minutes (p<0.001); and boarding time decreased from 298.9 (109.5–1149.0) minutes to 204.1 (98.7–545.7) minutes (p<0.001). In pre-protocol period, boarding patients accumulated in the ED during the weekdays and resolved on Friday, but this pattern was alleviated in post-period. Conclusion: The boarding restriction protocol was effective in alleviating ED crowding by reducing the accumulation of boarding patients in the ED during the weekdays.

Original languageEnglish
Pages (from-to)470-479
Number of pages10
JournalYonsei medical journal
Issue number5
Publication statusPublished - 2022 May

Bibliographical note

Funding Information:
This work was supported by the National Research Foundation of Korea grant funded by the Korea government (Ministry of Science and ICT) (no. 2017R1C1B5076958).

Publisher Copyright:
© Yonsei University College of Medicine 2022.

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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