ICJEM
Intercontinental Journal of Emergency Medicine

The Intercontinental Journal of Emergency Medicine aims to publish issues related to all fields of emergency medicine and all specialties involved in the management of emergencies in the hospital and prehospital environment of the highest scientific and clinical value at an international level and accepts articles on these topics.

eISSN: 2980-1400
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Original Article
The effect of emergency department boarding time on mortality of hospitalized COVID-19 patients
Abstract
Aims: To investigate whether prolonged emergency department length of stay is associated with increased mortality and altered clinical outcomes in critically ill COVID-19 patients requiring intensive care admission. This study aimed to evaluate the association between emergency department length of stay (ED-LOS) and mortality among COVID-19 patients admitted to intensive care units (ICUs) during the pandemic.
Methods: This retrospective observational study included 258 adult patients who were admitted from the ED to COVID-19 ICUs between March 29, 2020, and January 17, 2021. Patients were categorized based on ED-LOS into two groups: “8 hours or less” and “more than 8 hours.” Demographic data, comorbidities, PCR test results, ED-LOS, ICU length of stay, and mortality outcomes were collected and analyzed using the Mann-Whitney U and Chi-square tests.
Results: The median ED-LOS for all patients was 8 hours (IQR: 4–14). Among the 181 patients who died (70.2%), the median ED-LOS was 8 hours (IQR: 4–13.5), compared to 6 hours (IQR: 4–14) in survivors (p=0.216). The median time to mortality was 8 days in the ?8-hour group and 6 days in the >8-hour group (p=0.701). ICU length of stay was 10.5 days (IQR: 4–17) in the ?8-hour group and 9 days (IQR: 4–18) in the >8-hour group (p=0.627). No statistically significant association was found between ED-LOS and mortality or ICU stay duration.
Conclusion: While no statistically significant relationship was observed between ED-LOS and mortality, patients who remained in the ED longer tended to experience earlier mortality and shorter ICU stays. These findings suggest that ED-LOS alone may not fully explain outcomes in critically ill COVID-19 patients and that system-level interventions such as early ED-based critical care and streamlined ICU transfers may play a vital role. Future research should explore these dynamics using multicenter, severity-adjusted designs.

Keywords : Emergency department, length of stay, COVID-19, ICU mortality, triage delay, ED overcrowding

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1. Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265-269. doi:10.1038/s41586-020-2008-3
2. Harvey WT, Carabelli AM, Jackson B, et al. SARS-CoV-2 variants, spike mutations and immune escape. Nat Rev Microbiol. 2021;19(7):409-424. doi:10.1038/s41579-021-00573-0
3. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of COVID-19-final report. N Engl J Med. 2020;383(19):1813-1826. doi:10.1056/NEJMoa2007764
4. Zhu N, Zhang D, Wang W, et al. A Novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733. doi:10.1056/NEJMoa2001017
5. Morawska L, Cao J. Airborne transmission of SARS-CoV-2: the world should face the reality. Environ Int. 2020;139(April):105730. doi:10.1016/j.envint.2020.105730
6. World Health Organization. WHO coronavirus (COVID-19) dashboard. Geneva: World Health Organization; 2023. Available from: https://covid19.who.int/
7. World Health Organization. Managing COVID-19 in the emergency department. Geneva: World Health Organization; 2020. Available from: https://www.who.int/publications/i/item/managing-covid-19-in-the-emergency-department
8. Centers for Disease Control and Prevention. Emergency department visits during the COVID-19 pandemic. Atlanta: CDC; 2020. Available from: https://www.cdc.gov/
9. Sun Y, Heng BH, Tay SY, Seow E. Predicting hospital admissions at emergency department triage using routine administrative data. Acad Emerg Med. 2011;18(8):844-850. doi:10.1111/j.1553-2712.2011.01125.x
10. Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2): 126-136.e1. doi:10.1016/j.annemergmed.2008.03.014
11. Singer AJ, Thode Jr HC, Viccellio P, Pines JM. The association between length of emergency department boarding and mortality. Acad Emerg Med. 2011;18(12):1324-1329. doi:10.1111/j.1553-2712.2011.01236.x
12. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032
13. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020; 323(20):2052-2059. doi:10.1001/jama.2020.6775
14. Republic of Turkey Ministry of Health. COVID-19 adult patient treatment guidelines (erişkin hasta tedavisi). Ankara, Turkey; 2022. Available from: https://covid19.saglik.gov.tr/
15. Republic of Türkiye Ministry of Health. Regulation on the procedures and principles of emergency department services in inpatient health facilities. Official Gazette. 2009;27378.
16. Sağlık Bakanlığı. COVID-19 (SARS-CoV-2 enfeksiyonu) erişkin hasta tedavisi. 2021;19:10,13. Available from: https://covid19.saglik.gov.tr/Eklenti/40719/0/covid-19rehberieriskinhastayonetimivetedavipdf.pdf
17. Asheim A, Nilsen SM, Carlsen F, et al. The effect of emergency department delays on 30-day mortality in Central Norway. Eur J Emerg Med. 2019;26(6):446-452. doi:10.1097/MEJ.0000000000000609
18. Paton A, Mitra B, Considine J. Longer time to transfer from the emergency department after bed request is associated with worse outcomes. Emerg Med Australas. 2019;31(2):211-215. doi:10.1111/1742-6723.13120
19. Boudi Z, Lauque D, Alsabri M, et al. Association between boarding in the emergency department and in-hospital mortality: a systematic review. PLoS One. 2020;15(4):1-23. doi:10.1371/journal.pone.0231253
20. Tuttle E, Wisecup C, Lemieux E, Wang X, Modrykamien A. Critically ill patients boarding in the emergency department and the association with intensive care unit length of stay and hospital mortality during the COVID-19 pandemic. Baylor Univ Med Cent Proc. 2022;35(2):145-148. doi:10.1080/08998280.2021.2014761
21. Conway R, Grimshaw AA, Konig MF, et al. SARS-CoV-2 infection and COVID-19 outcomes in rheumatic diseases: a systematic literature review and meta-analysis.Arthritis Rheumatol. 2022;74(5):766-775. doi:10.1002/art.42030
22. Groenland CNL, Termorshuizen F, Rietdijk WJR, et al. Emergency department to ICU time is associated with hospital mortality. Crit Care Med. 2019;47(11):1564-1571. doi:10.1097/CCM.0000000000003957
23. Plunkett PK, Byrne DG, Breslin T, Bennett K, Silke B. Increasing wait times predict increasing mortality for emergency medical admissions. Eur J Emerg Med. 2011;18(4):192-196. doi:10.1097/MEJ.0b013e328344917e
24. Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP, DELAY-ED study group. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007;35(6):1477-1483. doi:10.1097/01.CCM.0000266585.74905.5A
25. Jones S, Moulton C, Swift S, et al. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emerg Med J. 2022;39(3):168-173. doi:10.1136/emermed-2021-211572
26. Ashkenazi I, Gefen L, Hochman O, Tannous E. The 4-hour target in the emergency department, in-hospital mortality, and length of hospitalization: a single center-retrospective study. Am J Emerg Med. 2021;47:95-100. doi:10.1016/j.ajem.2021.03.049
27. Altınbilek E, Öztürk D, Atasoy C, Özlem M, Yılmaz F, Kavalci C. Analysis of the patients who admitted to a Turkish emergency department during COVID-19 pandemic. Acta Biomed. 2020;91(4): e2020201. doi:10.23750/abm.v91i4.10227
28. Şanci E, Bayram B, Emecen AN, et al. Comparative analysis of emergency department admissions: a multi-center study on patient characteristics and mortality before and during the early phase of pandemic in Turkey. Medicine (Baltimore). 2025;104(37):e44438. doi:10.1097/MD.0000000000044438
Article available in :
Volume 4, Issue 2, 2026
Page : 29-33
https://doi.org/10.51271/ICJEM-0074
Article Information
Received : 05 Şub 2026
Accepted : 11 Mar 2026
Published : 04 Haz 2026
Corresponding Author :

Mustafa Girayhan Ünlü: Department of Emergency Medicine, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkiye

[email protected]
Citation : Ünlü MG, Yüzbaşıoğlu Y, Özen D, Katırcı Y, Tüllü AB. The effect of emergency department boarding time on mortality of hospitalized COVID-19 patients. Intercont J Emerg Med. 2026;4(2):29-33. doi:10.51271/ICJEM-0074

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