361 Quantifying Changes in Daily Census Across Emergency Departments in 2018 and 2023: A Call to Action

Document Type

Conference Proceeding

Publication Date

9-1-2025

Publication Title

Ann Emerg Med

Abstract

Study Objective: To compare daily patient census data between academic, community and freestanding emergency departments (EDs) within a single health system in the pre- and post-COVID-19 era (2018-2023). Methods: This retrospective study was conducted across multiple EDs in a health system in southeastern Michigan. Operational data from three distinct ED settings (one academic, four freestanding, and four community) were reviewed for the years 2018 and 2023. The primary metric was the median treatment census by hour of the day for each site, assessing patient volume at specific times. The number of patients for each hour of the day was plotted along the Y- and X-axes. This analysis was performed separately for each year (2018 and 2023) and each ED setting. We calculated the percentage of variance between the lowest and peak patient census for each ED setting/year to assess daily variation. To compare daily census differences between 2018 and 2023, we focused on two time points: 7 am and 8 pm and calculated the relative percent increase in census between these times. Data from the four freestanding and four community EDs were aggregated and compared to the academic center using two-way analysis of variance (ANOVA). Results: The lowest daily census consistently occurred around 7 am, and the highest around 8 pm across all sites in both 2018 and 2023. Freestanding EDs exhibited the greatest fluctuations in census compared to other EDs (p <0.001). In 2018, the freestanding EDs had a median census of 11 patients at 7 am and 51 patients at 8 pm, with a variability of 462%. In 2023, the median census at 7 am was 16, and at 8 pm, it was 62, representing a 387% variability. Community EDs exhibited similar trends but with lower variability. In 2018, the median census at community EDs was 59 at 7 am and 170 at 8 pm, reflecting a 288% increase. In 2023, the median census was 105 at 7 am and 196 at 8 pm, a 186% increase. The academic center had the least variability in daily census (p <0.001). In 2018, the median census at the academic site was 48 at 7 am and 82 at 8 pm (a 121% increase), while in 2023, the census was 78 at 7 am and 92 at 8 pm (a 117% increase). Total yearly volume for the four freestanding EDs was 129,547 in 2018 and 128,156 in 2023. The community EDs had a total yearly volume of 244,753 in 2018 and 228,896 in 2023, while the academic center had 101,210 in 2018 and 84,792 in 2023. Conclusion: This study reveals consistent daily census fluctuations across ED settings, with freestanding and community EDs experiencing greater hourly variability than academic sites. Post-COVID trends show reduced total volume but persistently elevated hourly census, likely reflecting longer lengths of stay and delayed throughput. The academic ED’s stable census pattern may indicate ongoing boarding challenges. These insights can guide EDs in adjusting staffing models, anticipating peak times, and developing targeted surge protocols across diverse care environments. [Formula presented] No, authors do not have interests to disclose

Volume

86

Issue

3

First Page

S156

Last Page

S157

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