Impact of Boarding Time on In-Hospital Mortality in Patients Presenting to an Oncologic Emergency Department of a Comprehensive Cancer Center.

Objectives: Longer boarding time in emergency departments (EDs) has been associated with negative clinical outcomes, including higher mortality rates. Studies of boarding to date have been conducted in the general population but not in the cancer population. In this study, we evaluated the association between mortality and boarding time in patients presenting at an oncologic ED. Methods: This retrospective study included all ED visits for patients aged ≥19 years who presented to The University of Texas MD Anderson Cancer Center ED between March 3, 2016 and December 31, 2022, with a disposition of hospital admission. Univariate and multivariable logistic regression analyses were performed to determine the associations between boarding time and in-hospital mortality. Results: The final patient cohort included 43,308 patients. The median boarding time was 2.7 hours (interquartile range = 1.5-5.2 hours), with an in-hospital mortality rate of 7.0% (n = 3029). Death occurred in 6.9% of patients (n = 2997) within 14 days of ED presentation and increased to 13.7% (n = 5941) within 30 days. Patients with boarding times ≥5.2 hours had a 24% higher odds of in-hospital mortality compared with patients with <1.5 hours (odds ratio = 1.24; 95% confidence interval = 1.11-1.38; P < .001) after controlling for common clinical and cancer-related factors. Conclusion: Longer ED boarding times were associated with higher in-hospital mortality rates after hospital admission. These results emphasize the need for improved strategies to expedite the admission process and optimize care transitions for cancer patients in the ED to reduce mortality rates, especially for patients with complex medical needs and high-acuity presentations.