More Patients Lack Care Access as Emergency Department Wait Times Spike

A pair of new studies shine a light on how overcrowding and staffing shortages may be impacting emergency department (ED) wait times and patient care access.

The studies, based on EHR data from across the country, were published in JAMA Network Open by researchers from the VA Ann Arbor Healthcare System, the University of Michigan Institute for Healthcare Policy and Innovation, and Yale University.

In the first study, researchers examined how hospital occupancy, the percentage of occupied staffed inpatient beds, was associated with long ED wait length or boarding times.

Between January 2020 and December 2021, researchers found that boarding times were greater than four hours nearly 90 percent of the time when occupancy was greater than 85 percent.

The Joint Commission, a national accrediting body for hospitals, stressed that boarding times over four hours is a patient safety concern.

Additionally, during the study period, patients were found to wait an average of 6.5 hours for a bed compared to only 2.4 hours during other months. Throughout 2020 and 2021, boarding times further increased, outpacing occupancy rates.

By December 2021, median boarding times were over nine hours at the five percent of hospitals with the greatest occupancy.

“It’s a measure of access to care,” Alex Janke, MD, MHS, the lead author of both studies, said in a press release.  “If you have to wait hours and hours to be evaluated in the ED, then that’s not the access to care that we have required by law in [the Emergency Medical Treatment and Active Labor Act, or EMTALA].”

When EDs are overcrowded and wait times are long, patients are more likely to leave EDs before clinical evaluation. The second study examined the rate at which patients left the ED without being seen by a physician.

Researchers found that the median rate of patients leaving the ED without being seen nearly doubled from 1.1 percent to 2.1 percent from January 2017 to December 2021.

Among the worst-performing hospitals, 10 percent of ED patients left before a medical evaluation. This number was nearly twice as high as the rate of patients who left in 2017 and the early part of 2020.

Researchers noted that this poor performance demonstrates that the ED system failed to maintain patient care access during the pandemic. The healthcare system did not have enough resources, especially as the physician shortage increased during this period.

“This is not an ED management issue,” Arjun Venkatesh, an associate professor of emergency medicine at Yale School of Medicine and an author of the studies, said in a press release. “These are indicators of overwhelmed resources and symptoms of deeper problems in the healthcare system.”

These findings provide a look into the current state of emergency care access throughout America, but they also point to a greater issue, the researchers stated.

“Emergency departments are the levees on acute care demands in the U.S.,” said Janke, who trained at Yale before going to Michigan. “While once there were decompression periods in even the busiest EDs, what we are seeing here, as others are seeing in Canada and the U.K., demonstrates that the levees have broken.”

ED overcrowding has been an issue since the 1980s when it emerged as a national concern. However, it seems the problem has only worsened since then.

“Boarding and overcrowding in EDs have been a growing issue for over 30 years. Incredible work has been done in the emergency medicine community to make our care better, more accurate, and nimbler using limited resources,” said Janke. “But without more space and staff in the hospital, and downstream in skilled nursing facilities and across community settings, this crisis will continue.”