OBJECTIVES: Higher boarding times (BTs) usually affect the Emergency Departments’ (EDs) activities, resulting in a lower care quality level for patients, waiting for an inpatient bed. This study aims to evaluate the different EDs performance indicators affecting BT.

METHODS: Real-life data were collected in an ED in Northern Italy, considering the years 2019-2022, and referring to 189,976 accesses (134,199 adults and 55,777 pediatrics). The following KPIs were assessed: time between ED access and the first visit, BT, ED overall stay, ED repeated access within 72 hours. Both the National Emergency Department Overcrowding Scale (NEDOCS) and the Emergency Department Working Index (EDWIN) were adopted. All measures were compared to the national standards. A bivariate correlation was performed to explain endogenous and exogenous factors, that could impact on the patients’ BT.

RESULTS: Time between ED access and the first visit results over the national standards, for all the patients, except for white and green patients (referring to pediatric department). Repeated accesses within 72 hours increased for white and green patients; a decreasing trend was registered for red and yellow patients, especially in the children’s pediatric department. Stratifying the accesses and evaluating the NEDOCS index, in the pediatric department overcrowding situations were demonstrated only for the light-blue and green patients. The bivariate analyses revealed that time band (β=-0.057; p-value=0.000), patient's code (β=-0.028; p-value=0.005), and ED organizational assets (β=0.039; p-value=0.000) could affect the BT, with an increase during the night and for the less complex codes.

CONCLUSIONS: BT resulted higher at night, as a consequence of the reduced number of recovered patients, increasing the overcrowding. The overall process time is enlarged over the years 2020-2021, also due to the COVID-19 spread; better results emerged in 2022. EDWIN and NEDOCS indexes could be considered as relevant indicators, providing more comprehensive information for understanding EDs dynamics and improving EDs management.