486 Comparing emergency department patient care hours in pre-COVID-19 and post-COVID-19 eras

Document Type

Conference Proceeding

Publication Date

5-13-2024

Publication Title

Acad Emerg Med

Abstract

Background and Objectives: Previous research shows the development of significant emergency department (ED) boarding during and after the COVID-19 pandemic and an increase in length of stay (LOS) time. Labor productivity benchmarks used in staffing ED's are commonly based on units of service (e.g., annual patient volume) without consideration of boarding or ED length of stay (LOS). These metrics may argue for fewer staff to cover the ED even when due to the increased LOS, more patients are present in the ED and receiving care. This retrospective data abstraction compared the ED annual volume, patient care hours delivered, and ED LOS in 2019 and 2022 to hypothesize that by increasing LOS time, providing longer care for fewer patients annually may require additional staffing, not less. Methods: Data was retrospectively abstracted from the electronic medical record for 2019 and 2022. The median census of patients receiving treatment (excluding the waiting room census) in the ED during that calendar year was plotted by hour of the day. The area under the curve was calculated to get the median patient care hours per day. We compared the total number of ED visits, median daily patient care hours delivered, and the median ED LOS. This study was evaluated by our hospital's IRB and deemed exempt and not human subject research. Results: Annual patient visits to the ED in 2019 and 2022 were 99,431 and 78,924, respectively. Median patient care hours per day in 2019 and 2022 were 1740 and 1909 respectively. Median ED LOS for all patients was 332?min in 2019 and 474 in 2022. Annual patient care hours delivered in 2019 were 635,100?h compared to 696,785?h in 2022. Despite a 20.6% reduction in annual patient visits, ED LOS increased by 42.8% during this period leading to an overall 9.7% increase in patient care hours delivered in 2022. Conclusion: In 2022, increased ED LOS resulted in more patient-hours of care provided per day despite fewer annual visits to the ED. This data suggests that ED staff are providing more patient care now than before the pandemic, despite fewer visits and that increased staffing may be required. When used for staffing decisions, labor productivity benchmarks relying crudely on annual visits may benefit from adjusting for increases in LOS times to gauge more adequately the personnel required.

Volume

31

Issue

S1

First Page

229

Last Page

230

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