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ACEP Now: Vol 39 – No 11 – November 2020(click for larger image) Figure 2. ED transfer % by cohort
These numbers are primarily driven by smaller hospitals, but all types of emergency departments are trending toward more patient transfers. Of note, these data do not include freestanding emergency departments, which can place additional burdens on the transfer resources of hospitals and hospital systems.
3) The percentage of patients admitted from the emergency department to the hospital has rapidly increased.
About 67 percent of hospital admissions are processed through the emergency department. These admissions include patients seen in the emergency department and then placed in any inpatient area of the hospital, either as “full admission” or “observation status.” High-volume and adult-serving emergency departments tend to have high admission rates.
The average has increased from prior years to 22 percent (see Figure 3).
(click for larger image) Figure 3. Percent of ED patients admitted
4) Patients who require ED boarding challenge ED operations.
Boarding time is an important contributor to overall patient processing, and it has remained stubbornly high, an annual average of about 115 minutes between 2012 and 2019.
ED boarding, time from decision-to-admit until the patient physically leaves the emergency department, remains a burden on ED performance. It accounts for about 38 percent of the time admitted patients spend in the emergency department. This time interval has been part of each hospital’s required data submission to the Centers for Medicare & Medicaid Services since 2013, and results are posted on the Hospital Compare website (www.medicare.gov/hospitalcompare). It was hoped that public posting of boarding would motivate hospital administrators to improve this metric. Unfortunately, despite the work of many ED and hospital leaders to reduce boarding time, the data for 2019 list the average interval at 118 minutes.
The EDBA Performance Measures Summits have been used to unify the definitions used across the industry, and that process has been used to accurately define boarding time and the burden on the emergency department of admitted patients. There is ongoing work to identify hospitals that have reduced boarding time by making ED patient flow more efficient.
Prioritizing ED Management Challenges
The need for emergency physicians has dramatically increased due to patient needs and medical system challenges fueled by the COVID-19 pandemic. However, the advent of telemedicine programs has provided another ready source of care for patients with low-acuity, unscheduled care needs; those patients will largely disappear from the ED population for the foreseeable future.
Emergency physician leaders must appreciate trends present through 2019 and work collaboratively with hospital leaders to serve a changing emergency population in 2021 and beyond. The need to move admitted patients up to the inpatient units is a particularly important management priority.
The EDBA Summits have provided a dedicated group of federal, regional, and emergency leaders the opportunity to develop reasonable standards and performance measures for the industry. The definitions published after the 2018 summit have recently been published, and they provide guidance to ED leaders who are developing data management processes that improve performance.1
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