Introduction: Boarding, understood as the patient's stay in the Emergency Department after the decision to admit and while awaiting transfer to an inpatient ward, represents one of the main manifestations of output block and hospital overcrowding. Although it is often considered a logistical problem predominantly, the phenomenon also involves clinical, decision-making, and organizational aspects. Objective: To analyze the phenomenon of boarding at the Emergency Department of the Infermi Hospital in Rimini, with particular attention to patients initially classified for admission and subsequently discharged home, evaluating the variability of the decision-making process and the potential implications for healthcare safety. Methods: A single-center retrospective observational study was conducted on data relating to the year 2025, during which 60,049 visits to the general Emergency Department were recorded. For the in-depth analysis of patients discharged home after being classified in boarding, the months of January and July 2025 were selected. The analysis was integrated through an anonymous questionnaire addressed to Emergency Department physicians, to which 16 out of 24 professionals responded, and through the examination of incident reporting notifications related to the three years 2023–2025. Results: In 2025, 11,065 patients were classified in boarding, with an average boarding time of 328 minutes, compared to 278 minutes recorded in 2024. Overall, 469 patients, equal to 4.2% of the total, were subsequently discharged home. In the months of January and July, this share was 4.7% and 4.8%, respectively, with no statistically significant differences (p = 0.87). The in-depth analysis included 98 patients: 38% had passed through the Short Intensive Observation unit (OBI), and 70.4% had experienced a physician handover between the boarding classification and discharge. The questionnaire revealed that the decision-making process is influenced both by clinical factors, such as patient instability, indicated by 62.5% of respondents, and by organizational factors, including bed availability (37.5%) and the time required for specialist consultations (18.8%). The analysis of incident reporting revealed the occurrence of falls even during the OBI and boarding phases; notifications regarding assaults on healthcare workers and critical issues in the transfusion process further contributed to describing a healthcare context characterized by high complexity. Conclusions: Boarding does not exclusively represent a delay in transfer to the inpatient ward, but constitutes a complex phase of care in which clinical, decision-making, and organizational aspects intertwine. The observed variability in patient times and pathways highlights the opportunity to define more widely shared criteria for the classification and management of boarding, strengthening clinical-care monitoring and integration among the Emergency Department, Bed Management, and inpatient wards.
Introduzione: Il boarding, inteso come la permanenza del paziente in Pronto Soccorso dopo la decisione di ricovero e in attesa del trasferimento in reparto, rappresenta una delle principali manifestazioni dell’output block e del sovraffollamento ospedaliero. Sebbene venga spesso considerato prevalentemente un problema logistico, il fenomeno coinvolge anche aspetti clinici, decisionali e organizzativi. Obiettivo: Analizzare il fenomeno del boarding presso il Pronto Soccorso dell’Ospedale Infermi di Rimini, con particolare attenzione ai pazienti inizialmente classificati per il ricovero e successivamente dimessi a domicilio, valutando la variabilità del processo decisionale e le possibili implicazioni per la sicurezza assistenziale. Metodi: È stato condotto uno studio osservazionale retrospettivo monocentrico sui dati relativi all’anno 2025, durante il quale sono stati registrati 60.049 accessi al Pronto Soccorso generale. Per l’analisi approfondita dei pazienti dimessi a domicilio dopo la classificazione in boarding sono stati selezionati i mesi di gennaio e luglio 2025. L’analisi è stata integrata mediante un questionario anonimo rivolto ai medici del Pronto Soccorso, al quale hanno risposto 16 professionisti su 24, e attraverso l’esame delle segnalazioni di incident reporting relative al triennio 2023–2025. Risultati: Nel 2025 sono stati classificati in boarding 11.065 pazienti, con un tempo medio di boarding pari a 328 minuti, rispetto ai 278 minuti registrati nel 2024. Complessivamente, 469 pazienti, pari al 4,2% del totale, sono stati successivamente dimessi a domicilio. Nei mesi di gennaio e luglio tale quota è risultata rispettivamente del 4,7% e del 4,8%, senza differenze statisticamente significative (p = 0,87). L’analisi approfondita ha incluso 98 pazienti: il 38% era transitato in Osservazione Breve Intensiva e il 70,4% aveva presentato un cambio medico tra la classificazione in boarding e la dimissione. Dal questionario è emerso che il processo decisionale risulta influenzato sia da fattori clinici, come l’instabilità del paziente, indicata dal 62,5% dei rispondenti, sia da fattori organizzativi, tra cui la disponibilità dei posti letto (37,5%) e i tempi necessari per le consulenze specialistiche (18,8%). L’analisi dell’incident reporting ha rilevato la presenza di cadute anche durante le fasi di OBI e boarding; le segnalazioni relative alle aggressioni agli operatori e alle criticità del processo trasfusionale hanno inoltre contribuito a descrivere un contesto assistenziale caratterizzato da elevata complessità. Conclusioni: Il boarding non rappresenta esclusivamente un ritardo nel trasferimento verso il reparto di degenza, ma costituisce una fase assistenziale complessa, nella quale si intrecciano aspetti clinici, decisionali e organizzativi. La variabilità osservata nei tempi e nei percorsi dei pazienti evidenzia l’opportunità di definire criteri maggiormente condivisi per la classificazione e la gestione del boarding, rafforzando il monitoraggio clinico-assistenziale e l’integrazione tra Pronto Soccorso, Bed Management e reparti di degenza.
STUDIO OSSERVAZIONALE SUL BOARDING IN PRONTO SOCCORSO: ANALISI DEL PROCESSO DECISIONALE NEI PERCORSI DI RICOVERO E DIMISSIONE
MAIOLATESI, FEDERICA
2025/2026
Abstract
Introduction: Boarding, understood as the patient's stay in the Emergency Department after the decision to admit and while awaiting transfer to an inpatient ward, represents one of the main manifestations of output block and hospital overcrowding. Although it is often considered a logistical problem predominantly, the phenomenon also involves clinical, decision-making, and organizational aspects. Objective: To analyze the phenomenon of boarding at the Emergency Department of the Infermi Hospital in Rimini, with particular attention to patients initially classified for admission and subsequently discharged home, evaluating the variability of the decision-making process and the potential implications for healthcare safety. Methods: A single-center retrospective observational study was conducted on data relating to the year 2025, during which 60,049 visits to the general Emergency Department were recorded. For the in-depth analysis of patients discharged home after being classified in boarding, the months of January and July 2025 were selected. The analysis was integrated through an anonymous questionnaire addressed to Emergency Department physicians, to which 16 out of 24 professionals responded, and through the examination of incident reporting notifications related to the three years 2023–2025. Results: In 2025, 11,065 patients were classified in boarding, with an average boarding time of 328 minutes, compared to 278 minutes recorded in 2024. Overall, 469 patients, equal to 4.2% of the total, were subsequently discharged home. In the months of January and July, this share was 4.7% and 4.8%, respectively, with no statistically significant differences (p = 0.87). The in-depth analysis included 98 patients: 38% had passed through the Short Intensive Observation unit (OBI), and 70.4% had experienced a physician handover between the boarding classification and discharge. The questionnaire revealed that the decision-making process is influenced both by clinical factors, such as patient instability, indicated by 62.5% of respondents, and by organizational factors, including bed availability (37.5%) and the time required for specialist consultations (18.8%). The analysis of incident reporting revealed the occurrence of falls even during the OBI and boarding phases; notifications regarding assaults on healthcare workers and critical issues in the transfusion process further contributed to describing a healthcare context characterized by high complexity. Conclusions: Boarding does not exclusively represent a delay in transfer to the inpatient ward, but constitutes a complex phase of care in which clinical, decision-making, and organizational aspects intertwine. The observed variability in patient times and pathways highlights the opportunity to define more widely shared criteria for the classification and management of boarding, strengthening clinical-care monitoring and integration among the Emergency Department, Bed Management, and inpatient wards.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/27149