Study Objectives
To describe trends in hospital occupancy, emergency department (ED) median boarding time, and ED left without being seen (LWBS) rates in national sample of 1,769 hospitals in 2020 and 2021.
Methods
This study utilized aggregated hospital-level operational measures available through a peer benchmarking service offered by Epic Systems Corporation to its customers. The benchmarking service confidentially compares the performance of organizations that opt to utilize the service. Measures were analyzed on a monthly basis for all months from January 2020 through December 2021. The analysis sample included 1,769 unique hospitals across 331 organizations in the U.S.. Measures were first calculated at the hospital- level, and then aggregated statistics including median and percentiles for those measures were reported across all hospitals utilizing the service, as well as for subsets of those hospitals within each U.S. Census Region (Northeast, Midwest, South, West). Hospital-level operational measures of strain included hospital occupancy (percentage of staffed inpatient beds that are occupied), ED median boarding time (the median wait in the ED for patients from decision to admit to transfer out of the ED to an inpatient bed), and percent of ED visits resulting in patient leaving prior to clinical evaluation or left without being seen (LWBS).
Results
The median of ED median boarding time across all 1,769 hospitals was 2.00 hours in January 2020, fell to a nadir of 1.58 hours in April 2020, and rose throughout the study period to a high of 3.43 (a 71% increase from January 2020) as of December 2021. Hospital occupancy rates were at their highest in January 2020 at a median of 69.7%, nadired at 48.7% in April 2020, and rose again to a high of 67.2% by September 2021. Occupancy rates and boarding time varied greatly and exhibited a threshold relationship where occupancy exceeded 80%. In those cases, ED median boarding time rose to a median across hospitals of 5.78 hours, and a 95th percentile of 8.60 hours. At the end of 2021, amongst the worst performing hospitals in the 95th percentile by these operational measures, half of admitted ED patients 9 hours or longer for an inpatient bed, and more than 1 in 10 patients who present to the ED leave prior to an evaluation.
Conclusion
Where hospital occupancy exceeded 80%, ED boarding rose far above the 4-hour standard set by The Joint Commission. Hospital occupancy was relatively static over time while ED boarding times and LWBS rates exhibited much more dramatic variation and peaked at the end of 2021. Policymakers must address dynamic crises of acute care system strain in future waves of the COVID-19 pandemic and other disasters, or risk further erosion of hospital system capacity, unsafe patient and health care worker conditions, and excess mortality.
No, authors do not have interests to disclose