Emergency Department Volume, Severity, and Crowding Since the Onset of the Coronavirus Disease 2019 Pandemic - 20/11/23
, Mark S. Zocchi, MPH c, Bernard S. Black, JD d, Pablo Celedon, MBA a, Andrew Leubitz, DO, MBA e, Ali Moghtaderi, PhD f, Dhimitri A. Nikolla, DO g, Nishad Rahman, MD h, Jesse M. Pines, MD, MBA a, ifor the
US Acute Care Solutions Research Group
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Abstract |
Study objective |
We describe emergency department (ED) visit volume, illness severity, and crowding metrics from the onset of the coronavirus disease 2019 (COVID-19) pandemic through mid-2022.
Methods |
We tabulated monthly data from 14 million ED visits on ED volumes and measures of illness severity and crowding from March 2020 through August 2022 compared with the same months in 2019 in 111 EDs staffed by a national ED practice group in 18 states.
Results |
Average monthly ED volumes fell in the early pandemic, partially recovered in 2022, but remained below 2019 levels (915 per ED in 2019 to 826.6 in 2022 for admitted patients; 3,026.9 to 2,478.5 for discharged patients). The proportion of visits assessed as critical care increased from 7.9% in 2019 to 11.0% in 2022, whereas the number of visits decreased (318,802 to 264,350). Visits billed as 99285 (the highest-acuity Evaluation and Management code for noncritical care visits) increased from 35.4% of visits in 2019 to 40.0% in 2022, whereas the number of visits decreased (1,434,454 to 952,422). Median and median of 90th percentile length of stay for admitted patients rose 32% (5.2 to 6.9 hours) and 47% (11.7 to 17.4 hours) in 2022 versus 2019. Patients leaving without treatment rose 86% (2.9% to 5.4%). For admitted psychiatric patients, the 90th percentile length of stay increased from 20 hours to more than 1 day.
Conclusion |
ED visit volumes fell early in the pandemic and have only partly recovered. Despite lower volumes, ED crowding has increased. This issue is magnified in psychiatric patients.
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| Please see page 651 for the Editor’s Capsule Summary of this article. |
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| Supervising editors: Gillian R. Schmitz, MD; Steven M. Green, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: All authors conceived the study and designed the trial. BSB provided advice on study design. MSZ took the lead role in analyzing the data. JO drafted the manuscript and all authors contributed substantially to its revision. JO takes responsibility for the paper as a whole. |
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| Data sharing statement: The data dictionary and analytic code are immediately available on reasonable request to JJO (oskvarekj@usacs.com). USACS visit data is proprietary. |
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| 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). JMP has received payments from CSL Behring, Medtronic, Abbott Point of Care, Astra-Zeneca, Boeringher-Ingelheim, and Eagle Pharmaceuticals for unrelated work. The other authors have stated that no such relationships exist. The authors report this article did not receive any outside funding or support. This study was reported on behalf of the US Acute Care Solutions Research Group. |
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Vol 82 - N° 6
P. 650-660 - décembre 2023 Retour au numéro
Article précédent
- Funding Emergency Care in America: Searching for Solutions in a Highly Designed Mess
- Candace D. McNaughton, Sabrina J. Poon
- Emergency Department Crowding After Coronavirus Disease 2019: Time to Change the Hospital Paradigm
- Gillian R. Schmitz, Peter Viccellio, Eugene Litvak
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