Mitigating ED boarding during surge conditions: A multidisciplinary resilience model at a tertiary center epicenter.

BACKGROUND: Emergency department (ED) overcrowding and boarding intensified during the COVID-19 pandemic. We evaluated the association of a multidisciplinary rapid response team (RRT) with ED boarding during the 2021 surge in New Taipei City, Taiwan. METHODS: A retrospective quality improvement study was conducted at a 1058-bed, newly established tertiary referral hospital situated at the epicenter of the pandemic in Taiwan. In May 2021, an RRT implemented three strategies: (1) diversion of mild COVID-19 cases to quarantine centers via telemedicine, (2) real-time business intelligence (BI) dashboard monitoring for bed allocation, and (3) an ED-based outpatient parenteral antimicrobial therapy (OPAT) program. Primary outcomes were ED boarding time and the proportion of stays exceeding 48 h. RESULTS: Among 43,368 ED visits in 2021, median ED boarding time decreased from 58.4 h (IQR 42.2-76.8) during the pre-intervention period to 6.2 h (IQR 4.1-11.5) following RRT implementation (P < .001). The proportion of patients boarding >48 h decreased from 5.09% in June to 0.16% in December 2021. CONCLUSION: A coordinated, multidisciplinary approach integrating digital monitoring, community diversion, and alternative treatment pathways effectively maintained ED operational resilience during a public health crisis. This model offers an adaptable operational strategy for managing acute capacity strain and maintaining throughput during future epidemic surges.