Does Emergency Department Treatment Daily Census Correlate With Patient-Hours of Care Provided: A Comparison of Data from Pre-COVID-19 (2018) to Post-COVID-19 (2022)

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Ann Emerg Med

Abstract

Study Objectives: Previous studies have shown that emergency departments (EDs) have had increased Length-of-Stay (LOS) and Boarding times following the COVID-19 pandemic, it is unclear how temporal fluctuations in patient volume have been affected. Further, we suspect that EDs are seeing fewer patients but are having to provide more patient hours of care with the same staffing levels. Previously, we have seen increases in typical operational metrics -- Door to Doctor time, Left Without Completing services rate, and patients placed in Observation boarding--in a post-COVID-19 era, however the impact on ED throughput and resource utilization is unclear. We intend to demonstrate how differences in the daily ED volume and the patient hours of care delivered impact ED operations and to advise regarding staffing levels. Methods: Patient encounters in the ED at a single urban tertiary care hospital in the years 2018 (baseline) and 2022 (comparator) were reviewed retrospectively. ED volume was quantified as the current treatment census over a twenty-four hour period over the course of the year and the median, 75th, and 90th percentiles were plotted for both years. The treatment census value was measured as the median and excluded waiting room census. Patient hours of care (PHOC) was derived by multiplying the median daily treatment census by the LOS and calculated for each hour of the day. Median patient hours of care was plotted for both years. Data was collected retrospectively from our electronic medical record (EPIC). The research was reviewed by our hospital’s IRB and deemed exempt, and non-human subject research. Results: In 2018, the median census in the emergency department was as low as 38 patients at 07:00 and peaked between hours of 15:00 till 23:00 where the median census was 77. In 2022, the median census in the ED was 75 at 07:00 and the peak census occurred between 12:00 until 23:00 at 90. In 2018, the median number of per day PHOC provided was 1,434 hours per day versus 2022 where it was 2,023 PHOC per day. That is 589 PHOC per day more delivered in 2022 than in 2018 despite an annual census of 101,132 patients in 2022 and 78,872 patients in 2018. In 2018, the total PHOC was 524,000 hours which per patient, was 5.2 hours per patient versus in 2022, where the PHOC was 740,000 hours which per patient was 9.3 hours. Conclusions: In a post-COVID-19 era, our ED cared for fewer patients, delivered more patient hours of care per patient and experienced less throughput and maintained higher censuses at any point throughout the day. These findings are consistent with previous research on the operational impact of COVID-19 in the ED. These findings suggest that while most decisions on staffing utilize annual ED volume, patient hours of care could be a prudent metric to follow ED productivity.

Volume

84

Issue

4

First Page

S164

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