Despite the work of many ED physicians and leaders to preserve flow, boarding times in 2022 jumped to 192 minutes, from 121 minutes in 2020. This time interval is very cohort-dependent, depending on ED volume. The time from “door to decision” was about 198 minutes in 2022, despite increased use of diagnostic testing.

The percentage of patients who leave the ED prior to the completion of treatment (LBTC) increased to 4.6 percent in 2022, compared to 2.7 percent in 2019. This is the highest LBTC rate that has ever been seen, and means that about 7 million patients who wanted ED care left without that service. That amounts to more than $1 billion dollars in lost ED physician revenue.

The Challenges to Emergency Physicians Are Significant

Reflecting on the management challenges of EDs in the upcoming years, there is need to improve hospital flow, safety, and quality. With the lessons and data of 2022 in mind, the need to move admitted patients up to inpatient units is an obvious management priority.

Executive Summary of ED Operations in 2022

Volume was up from 2021. Volumes collapsed in 2020, but in 2023 EDs are now nearly back to 2019 volumes.

Outstanding ED work through the pandemic saved patients, hospitals, and medical staffs.

There is an increasing percentage of patients arriving in EDs via EMS, now averaging about 19.7 percent. Admission rates for EMS patients is about 36 percent. Pediatric volume in community EDs is up.

Mental health cases and ED violence are up significantly.

Door-to-clinician median time is down to 14 minutes. But overall ED flow has deteriorated, with ED median length of stay for all patients 199 minutes in 2022.

Processing of ED patients to inpatient units is crippling ED operations. Boarding times crashed all types of EDs. The median boarding time across all EDs was about 192 minutes in 2022, up from 119 minutes in 2019.

Poor flow is an incredible stress on ED staff, resulting in loss of ED staff of all disciplines. Walkaways have more than doubled.

Dr. Augustine is national director of prehospital strategy for US Acute Care Solutions based in Canton, Ohio; clinical professor of emergency medicine at Wright State University in Dayton, Ohio; and vice president of the Emergency Department Benchmarking Alliance.

Reference

1. Managing and measuring emergency department care: results of the fourth emergency department benchmarking definitions summit. Maame Y, et al. Academic Emergency Medicine. 2020;27:600–611.