Current State of Emergency Department Boarding: A Call to Reimagine Resource Allocation to Meet Patient Needs

Document Type

Conference Proceeding

Publication Date

5-13-2025

Publication Title

Acad Emerg Med

Keywords

adult, benchmarking, conference abstract, coronavirus disease 2019, electronic health record, emergency ward, female, health care system, human, major clinical study, male, Michigan, patient care, patient referral, patient visit, patient volume, resource allocation, tertiary care center

Abstract

Background and Objectives: Emergency Departments (EDs) are experiencing an unprecedented increase in boarding patients which is impacting the ability to provide efficient and safe patient care. While this issue is recognized in tertiary care hospitals, it remains less explored in community and freestanding EDs. The objective of this study is to explore the relationship between annual patient visits and patient hours of care provided in EDs. We hypothesize that despite decreasing annual patient visits, more hours of patient care are being provided. Methods: The electronic health record (EHR) in a Michigan health care system with 9 Emergency Departments were analyzed for 2018 and 2023. These include: 1 tertiary care hospital, 4 community EDs and 4 free standing EDs. Metrics included Total Annual Patient Volume, Daily census, and daily Patient Hours of Care (PHC). A descriptive analysis was used to identify trends and differences when comparing 2023 to 2018, in these different types of EDs. Results: For community EDs, total annual volumes decreased from 244,753 in 2018 to 228,896 in 2023, while PHC increased from 2,944 to 3,810. Freestanding EDs saw a slight decline in total annual volume, from 129,547 in 2018 to 128,156 in 2023, but daily PHC rose from 845 to 1,041. The tertiary care hospital ED experienced the most pronounced decline in total annual volume, from 101,210 in 2018 to 84,792, yet daily PHC significantly increased from 1,601 to 2,056. While all EDs experienced increased PHC in 2023 compared to 2018, the tertiary ED had the most significant drop in total annual census (16.2%), compared to both free standing (1.0%) and community EDs (6.5%). Conclusion: This study demonstrates a paradigm shift in ED utilization in the post COVID-19 era, with decreased patient volumes but increased PHC across health system EDs (tertiary referral, community, and free standing). Freestanding and community EDs saw slight annual volume decreases but significant percentage increases in PHC (23% versus 29.5% respectively). This PHC increase was slightly less pronounced in the tertiary care setting which also experienced significant reduction in annual volume. These trends highlight evolving patient care needs in Emergency Medicine and stress the importance of resource allocation and workforce adjustments to manage the increase of PHC.

Volume

32

Issue

S1

First Page

237

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