{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T19:48:16Z","timestamp":1779911296577,"version":"3.53.1"},"reference-count":12,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,10,27]],"date-time":"2024-10-27T00:00:00Z","timestamp":1729987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS029656"],"award-info":[{"award-number":["R01HS029656"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients who first meet clinical criteria for sepsis while boarding in the emergency department (ED) may not receive optimal sepsis care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>Assess the association between ED boarding status and sepsis quality of care and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study of adult patients admitted to a large academic hospital from July 2021 to October 2023 who had clinical features consistent with sepsis present while physically in the ED. We compared outcomes for patients who experienced time zero (T\u20100; the time clinical features of sepsis were first present) while boarding in the ED (physically in the ED but admitted to a different service) to those experiencing T\u20100 while still under the care of the ED provider team. We used logistic regression to estimate the association between ED boarding status at T\u20100 and compliance with the US Centers for Medicare &amp; Medicaid Services (CMS) Severe Sepsis and Septic Shock: Management Bundle (SEP\u20101) core measure, individual bundle element compliance, and hospital mortality adjusting for prespecified covariates. In a subgroup analysis among patients who had not already received antibiotics before T\u20100, we conducted a Cox proportional hazards model to estimate the association between boarding status on time\u2010to\u2010antibiotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 4795 patients meeting a clinical definition of sepsis in the ED, 422 (8.8%) experienced T\u20100 as ED boarders. These patients were similar in age, sex, and comorbidities compared with patients experiencing T\u20100 while still under ED care. Fewer patients with T\u20100 as an ED boarder received SEP\u20101 compliant care (25% vs. 38%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), including a lower proportion of fluid resuscitation (15% vs. 26%, <jats:italic>p<\/jats:italic>\u2009=\u2009.004) and lactate assessment (62% vs. 94%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Overall, more patients in the ED boarder group received antibiotics within 3 hours, but one\u2010third of patients had already received antibiotics prior to T\u20100. Among patients who had not already received antibiotics prior to T\u20100, experiencing T\u20100 as an ED boarder was associated with a decreased likelihood of receiving antibiotics (hazard ratio [HR]: 0.67 [95% confidence interval [CI], 0.54\u20130.84]) and longer time to antibiotics from T\u20100 (142\u2009min vs. 100\u2009min, <jats:italic>p<\/jats:italic>\u2009=\u2009.007).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Sepsis patients experiencing T\u20100 as a boarder in the ED have a lower likelihood of receiving SEP\u20101 compliant care compared to patients who experience T\u20100 while still under ED care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhm.13536","type":"journal-article","created":{"date-parts":[[2024,10,27]],"date-time":"2024-10-27T22:34:03Z","timestamp":1730068443000},"page":"368-373","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Characteristics, clinical care, and outcomes of sepsis among patients boarding in the emergency department"],"prefix":"10.1002","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8500-3697","authenticated-orcid":false,"given":"Jessica A.","family":"Blank","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie E.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hospital Medicine University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julieann F.","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hospital Medicine University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hospital Medicine University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachita","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hospital Medicine University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"England","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5809-7149","authenticated-orcid":false,"given":"David","family":"Paje","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hospital Medicine University of Michigan Ann Arbor Michigan USA"},{"name":"Institute for Health Policy and Innovation University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie P.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hospital Medicine University of Michigan Ann Arbor Michigan USA"},{"name":"Institute for Health Policy and Innovation University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,27]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"American College of Emergency Physicians.Policy Statement: Definition of Boarded Patient. American College of Emergency Physicians; 2018.https:\/\/www.acep.org\/siteassets\/new-pdfs\/policy-statements\/definition-of-boarded-patient.pdf"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2011.01236.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.10.026"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2014.06.001"},{"issue":"1","key":"e_1_2_10_6_1","first-page":"52","article-title":"Outcomes of crowding in emergency departments; a systematic review","volume":"7","author":"Rasouli HR","year":"2019","journal-title":"Arch Acad Emerg Med"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0289"},{"key":"e_1_2_10_8_1","unstructured":"Sepsis Bundle Algorithm for Q3 and Q4 2022.Center for Medicare and Medicaid Services: QualityNet\u2014Inpatient Hospitals Specifications Manual Sepsis Resources; 2022. Accessed September 25 2024.https:\/\/qualitynet.cms.gov\/inpatient\/specifications-manuals\/sepsis-resources"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004863"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202310-1800OC"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.07.008"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc13047"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.14423\/SMJ.0000000000001043"}],"container-title":["Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhm.13536","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T18:39:02Z","timestamp":1760639942000},"score":1,"resource":{"primary":{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/10.1002\/jhm.13536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,27]]},"references-count":12,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1002\/jhm.13536"],"URL":"https:\/\/doi.org\/10.1002\/jhm.13536","archive":["Portico"],"relation":{},"ISSN":["1553-5592","1553-5606"],"issn-type":[{"value":"1553-5592","type":"print"},{"value":"1553-5606","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,27]]},"assertion":[{"value":"2024-05-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}