The Emergency Department Benchmarking Alliance (EDBA) is a membership organization composed of high-performance emergency departments (EDs) that share a commitment to quality. The preliminary 2022 report contained performance measures for 938 EDs that managed more than 46 million patient visits, plus 222 additional freestanding EDs that served more than 4 million patients. Thus, the survey included data for about one-third of all patients seen in US ED’s in 2022.

Most Important Data Trends for Emergency Physicians and ED Leaders

Large losses (around 14 percent) in ED volume in 2020 reversed in 2021 and volumes increased further during 2022. In 2023, ED volumes are approaching those seen pre-pandemic at 66 percent.

EMS arrivals increased; many of those patients (35 percent) were admitted. A lower volume of walk-in patients resulted in a relative increase in patients arriving by EMS. Patient intake remained steady with median “Door to Bed” time decreasing to about eight minutes and “Door to Doctor” time to about 20 minutes. Long term trends remain intact, as these intake processing times decreased in most years since 2008, when the intake time was about 41 minutes.

Overall length of stay increased in EDs, with a subsequent large increase in the ED walkaway rate. The overall length of stay for all ED patients increased to 211 minutes in 2022, up from 194 minutes in 2021, 184 minutes in 2020, and 182 minutes in 2019. ED process times remain tightly correlated with volume of patients seen. Patients who require inpatient boarding remain a significant challenge to ed operations. About 19 percent of ED visits result in hospital admission and 66 percent of hospital admissions are processed through the ED. These numbers have been trending higher and 2022 was no exception.

The time interval referred to as ED boarding time has been part of the hospital’s required data submission to CMS since 2013. This is the time from “Decision to Admit” until the patient physically leaves the ED. Despite the work of ED and hospital leaders to reduce this time interval, Boarding Times had been stuck at around 120 minutes from 2013 to 2019. The pandemic saw the time interval increase. In the year 2021, the ED boarding time was 167 minutes, and in 2022 it soared to the 190-minute mark. This time interval is very cohort-dependent, ranging from 116 minutes in the smallest volume EDs, to 295 minutes in EDs that see more than 80,000 patients. The average ED Boarding Time of 190 minutes accounted for about 47 percent of the time the admitted patient spent in the ED. Unfortunately, the ED boarding measure is no longer required to be reported to CMS.¹