Boarding in US Academic Emergency Departments During the COVID-19 Pandemic - 16/08/23
, James J. Scheulen, PA, MBA c, Cathi A. Harbertson, MBA c, Rachel Gonzales, MPH a, Angira Mondal, MS b, Anish K. Agarwal, MD, MSHP a, b
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Abstract |
Study objective |
The first 2 years of the COVID-19 pandemic brought substantial and dynamic changes to emergency department volumes and throughput. The objective of this study was to describe changes in ED boarding among US academic EDs across the duration of the COVID-19 pandemic.
Methods |
We conducted a retrospective analysis of monthly data collected from a convenience sample of academic departments of emergency medicine. The study period was from January 2019 to December 2021. The primary outcome was total boarding hours, and secondary outcomes included patient volume stratified by ED disposition. We used multivariable linear panel regression models with fixed effects for individual EDs to estimate adjusted means for 3-month quarters.
Results |
Of the 73 academic departments of emergency medicine contacted, 34 (46.6%) participated, comprising 43 individual EDs in 25 states. The adjusted mean total boarding hours per month significantly decreased during the second quarter of 2020 (4,449 hours; 95% confidence interval [CI] 3,189 to 5,710) compared to the first quarter of 2019 (8,521 hours; 95% CI 7,845 to 9,197). Beginning in the second quarter of 2021, total boarding hours significantly increased beyond pre-pandemic levels, peaking during the fourth quarter of 2021 (12,127 hours; 95% CI 10,925 to 13,328).
Conclusions |
A sustained and considerable increase in boarding observed in selected US academic EDs during later phases of the COVID-19 pandemic may reflect ongoing stresses to the health care system, with potential consequences for patient outcomes as well as clinician well-being.
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| Please see page 248 for the Editor’s Capsule Summary of this article. |
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| Supervising editors: Hemal K. Kanzaria, MD; Richelle J. Cooper, MD, MSHS. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: ASK, JJS, CAH, and AKA conceived and designed the study. JJS and CAH undertook recruitment of participating centers. CAH managed the data, including quality control. ASK, AM, and AKA provided statistical advice on study design and analyzed the data. ASK, RG, and AKA drafted the manuscript, and all authors contributed substantially to its revision. ASK takes responsibility for the paper as a whole. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Dr. Kilaru is supported by the Agency for Healthcare Research and Quality (5K12HS026372-04). |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 82 - N° 3
P. 247-254 - septembre 2023 Retour au numéro
Article précédent
- Global Research Highlights
- The Unspoken Inequities of Our Boarding Crisis
- Hemal K. Kanzaria, Richelle J. Cooper
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