Wait times are up, and two new studies point to possible causes.
Even though COVID-19 cases are on a downward trend, emergency departments across the country are experiencing increased wait times, more patients boarding in the ED as they await beds, and longer overall lengths of stay. These alarming trends amount to much more than a frustration. They have negatively ripples across the entire health care system, including reduced access to care, increased medical errors, and even increased mortality.
Boarding and Throughput Headaches
A 2022 multicenter study published in the Annals of Emergency Medicine showed that increased boarding time in the ED is associated with longer door-to-provider (D2P) time. In fact, for each additional 10 minutes of boarding, there was an average 0.8-minute increase. In many hospitals, physicians are noting that boarding has hit a crisis point.
Data shows that boarding has a detrimental effect on throughput measures across the board, including increased wait times, D2P times, total ED length of stay of discharged patients (LOSD), and increased numbers of patients leaving before completion of treatment. After examining ED operational data from almost 900 hospitals in the ED Department Benchmarking Alliance (EDBA) database, the 2022 study found that boarding reduces throughput of nonboarded patients at a ratio of approximately 4:1.
According to Dr. Anthony Napoli of Brown University, co-author of the study:
Every 10 minutes of boarding in an ED is associated with an approximate 0.1% increase in LWBS and a 3-minute increase in LOSD […] we predicted that nearly 1 million patients may have potentially not received ED care due to boarding. Not only does this have a huge impact on hospital finances, but also the overall health of our patients.
Napoli stressed that boarding is a hospital capacity management issue, and that hospital leadership must be directly involved in plans to mitigate this problematic trend to the greatest extent possible.
Just as ED boarding has multiple effects on hospital operations and patient outcomes, it also has multiple causes. It is often a final symptom of systemic problems like staff turnover, patient flow issues, surgery schedules, and physician shortages. Organizations can craft the best data-driven solutions by examining their own systems and shortages using a multidisciplinary approach.
One popular efficiency solution, provider in triage (PIT), was the subject of a 2022 study in the Western Journal of Emergency Medicine. The study found that implementation of PIT was associated with a decrease in median D2P, and a moderate decrease in LOSD. However, after adjusting for variations in daily census, the effect of boarding on D2P and LOSD was unchanged, despite the addition of the PIT care model. The PIT model was unable to mitigate any of the effects of boarding.
Hybrid care models are gaining favor and showing very promising throughput results. Boarding of patients in the ED tends to happen for a couple of reasons. Patients are either waiting for an inpatient bed to open up, or they are waiting to be evaluated by a specialist, such as a psychiatrist.
Hybrid virtual care solutions can help solve both problems, first by working downstream to see inpatients where appropriate and to facilitate transfers from the ICU and discharges where appropriate. Second, telemedicine can be used for necessary consults in the ED, helping to reduce wait times and increasing access to physicians.
Initiating new efficiencies and effecting change in the ED requires customized solutions driven by performance data and careful analysis. With the right data partner, health care organizations can see the ED boarding picture more clearly and initiate a path forward to improvement.
At d2i, we’re working with EDs, hospitals, and telemedicine platforms to make the hybrid care model even more data-driven and robust. Contact d2i to learn more about our Emergency Medicine Performance Analytics, delivering purpose-built drill paths that let you access root-cause analysis with just one click.