There also was an increased use of electronic information systems. Computerized physician order entry (CPOE) is present in more than 90 percent of emergency departments. That’s high enough that CPOE is now considered ubiquitous technology, and the EDBA survey question related to it will be removed from future data surveys.

Despite the increase in volume, the survey found that patient processing in emergency departments has improved. The door-to-doctor time was about 27 minutes on average, and the overall length of stay for all emergency patients was less than three hours. About 75 percent of departments with an annual visit volume of more than 40,000 reported a “fast track” for patient care, and about 35 percent had a clinical decision unit or observation unit. The percentage of patients who left the emergency department prior to the completion of treatment, however, increased to 2.4 percent.

Transfer/Inpatient Boarding

Patients who require transfer and inpatient boarding are a significant challenge to emergency department operations. The inpatient units were the site of disposition of emergency patients in about 16 percent of visits, and about 1.4 percent of patients were transferred to another hospital, typically for admission. (The emergency department was the predominant front door for hospital admissions, with about 67 percent of hospital inpatients being processed through it.)

There was a stable volume of patient transfers: 1.4 percent of all patients, or almost 2 million a year. According to the 2011 CDC report, about one-third of patient transfers from emergency departments—or about 700,000 patients per year—were for mental health treatment.

The boarding time interval—the time from decision to admit until the patient physically leaves the emergency department—has stabilized for patients being placed in an inpatient unit of the hospital. The average boarding time in American departments was 111 minutes, but this time interval was very cohort-dependent. Emergency department inpatient boarding accounted for about 37 percent of the time an admitted patient spent in emergency. Boarding time ranged from about 170 minutes in departments with a patient volume of more than 80,000 to 67 minutes for departments seeing fewer than 20,000 patients. Emergency medicine leaders appear to have not been able to make much headway in reducing boarding time.

Emergency Medical Services

EMS continues to be an important source of volume for emergency departments, particularly for sicker patients. About 17 percent of patients arrived by EMS, and about 38 percent of those patients were admitted.