News: Boarding of patients in emergency departments has increased, new studies say

Two new research articles published by JAMA Network Open examine the boarding of patients in emergency departments (ED) and have noted an increase in both boarding and in the number of patients who left without being seen (LWBS). Among the worst performing hospitals, 4.3% of ED patients LWBS in early 2017, 4.4% in January 2020, and now up to 10% at the end of 2021. The strain of the COVID-19 pandemic and subsequent ED crowding and long waiting times are likely to blame, Healthleaders reported.

When LWBS rates are higher, potential negative consequences are more likely for patients if they defer care for acute conditions. The first ED boarding study used data collected from hospital measures data on a monthly basis from January 2020 to December 2021. Here are the main data points found:

• Hospital inpatient bed occupancy rates had a threshold association with boarding time. When occupancy rates were higher than 85%, ED boarding was higher than the Join Commission’s four-hour standard for 88.9% of hospital-months.
• For hospital-months with occupancy rates higher than 85%, the median ED boarding time was 6.58 hours versus 2.42 hours during other hospital-months.
• For all hospitals, the median ED boarding time was 2.00 hours in January 2020, 1.58 hours in April 2020, and 3.42 hours in December 2021.

The second LWBS study, collected from the same data and time period, found that the Median rates for hospital LWBS increased significantly from 1.1% in 2017 to 2.1% at the end of 2021. It also noted the previously mentioned increase of LWBS rates from 4.4% to 10% over the years. The study’s co-authors found these statistics most troubling, saying, “Access to emergency care cannot be considered universal until all patients presenting to EDs receive high-quality treatment for time-sensitive conditions. Given contributing system constraints, LWBS should be viewed as a failure to offer equitable access to acute care.”

Editor’s note: To read Healthleaders’ coverage of this story, click here. To read the ED boarding study, click here. To read the LWBS study, click here.