(P37) Increasing Emergency Department Boarding Times and Length of stay:covid-19 or a New Normal?

Objectives: Retrospective study evaluating Emergency Department (ED) length of stay (LOS), patient boarding, door to doctor time, and percent of patients left without completing service (LWCS) to evaluate if there is any correlation among these metrics.

Background: There was a dramatic loss of ED volume during the early phase of the pandemic (March 2020 – September 2020).ED visit volumes remain below pre-pandemic levels yet, our ED is struggling with increased overcrowding and patient boarding. We looked at these metrics to see if they correlate with each other. We believe objective data showing increased LOS and boarding serves as a justification for requests to hospital administration for more resources (physicians, nurses, technicians) despite reduced annual ED visit volume. The data also suggest that there may be lost revenue from patients who leave without completing service.

Methods: Data was collected prospectively from Electronic Medical Records (EPIC) from January 2019 to December 2022. There is an Inflow Statistics Board Function in EMR which was used to obtain desired numbers during this period. We examined the following metrics – average Emergency Department Length of Stay (ED LOS), average Inpatient and Observation Boarding time, average Door to Doctor time – (in minutes), and LWCS as percentage of ED volume. This study was evaluated by our hospital’s IRB and deemed exempt and not human subject research.

Results: The total annual number of patients seen in our ED is slowly increasing from the pre-intra-pandemic numbers. In 2019, pre-pandemic ED volume averaged 8285 patients per month. ED volume declined to 4200 patients per month in the early pandemic (April and May 2020). Overall volume for 2020 was 6568 patients per month. Monthly ED volume was 7137 and 6577 in 2021 and 2022, respectively. Inpatient and Observation Boarding numbers more than doubled from 419 minutes in 2019 to950 minutes in summer of 2021. Average ED LOS increased from 430 minutes in 2019 to 576 minutes in 2021, and to 676 minutes in 2022. Patient percentage of LWCS was closely correlated to LOS and Boarding time in minutes. The higher the LOS, the higher the percent of LWCS. LWCS in 2019, 2020, 2021, and 2022 was 6.47%, 5.70%, 11.82%, and 16.12%, respectively. Average boarding times from 2019 to 2022 were 419, 328, 617, and 742 minutes. The same correlation was found between LOS and Boarding time and Door to Doctor time – the longer LOS meant also increased time of Door to Doctor from approximately 60 minutesin 2019, 2020 to average of 180 minutes in late 2021 and 2022.

Conclusions: There is a direct correlation between an increase in LOS and Boarding time and the increase in percent of patients who LWCS, as well as Door to Doc time. These statistics can be used by ED leadership to inform hospital administration of the increased need for more resources in the form of hiring additional medical staff. Increased Door to Doctor time also directly correlates with % of LWCS. Decreasing Boarding/LOS should decrease % of LWCS patients and thus will assist in capturing lost revenue. This extra revenue may offset the investments used for hiring additional staff.

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Funding (Optional): None