Despite decades of efforts to change emergency care in U.S. hospitals and cope with ever-growing patient visits, the system is showing signs of serious strain, according to two new studies. .
The study has implications for health policy, and whether or not COVID-19 cases are surging, the availability of staffed hospital beds will impact the ability of emergency departments to serve patients. It provides data that shows it plays an important role.
A study based on national electronic health record data JAMA network open A team from VA Ann Arbor Healthcare System, University of Michigan Institute for Health Care Policy and Innovation, and Yale University.
The lead author of both studies, Alex Janke, MD, MHS, is a VAAHS and IHPI National Clinician Scholar and currently provides emergency care at VAAHS and Harley Hospital in Flint, Michigan. Better data is essential to guide government agencies, insurance companies and healthcare systems towards sustainable improvement.
“The emergency department is the dyke for the acute care needs of the United States,” says Janke, who trained at Yale University before coming to Michigan. “Even the busiest ED had periods of decompression, but what we see here indicates that dykes have breached, as we see in Canada and the UK.”
In one study, researchers looked at the percentage of emergency department patients who left without seeing a doctor, possibly due to long wait times in crowded situations.
The median percentage of all participating hospitals doubled from 2017 to the end of 2021, from just over 1% to just over 2%.
But then the researchers took a closer look at data from 1,769 hospitals surveyed at the end of 2021 and split the data by the percentage of patients discharged without being seen.
In 5% of hospitals, more than 10% of patients admitted to the emergency department were discharged before receiving a medical evaluation. That’s more than double what he was in comparable hospitals in 2017 and early 2020.
In a second study, researchers calculated the number of hours emergency department patients who required hospitalization had to wait in the ED before actually getting a hospital bed.
They examined how each hospital’s overall occupancy at boarding was related to the time patients had to wait in the ED to get a bed.
National accreditation bodies for hospitals recommend keeping boarding times to less than four hours to prevent treatment delays and known safety issues.
However, in this study, when more than 85% of hospital staffed beds were already occupied by other patients, patients admitted to the emergency department had to wait for a bed for more than 4 hours almost 90% of the time. It is shown that it should have been In fact, such a patient found that on average he waited more than 6.5 hours for bed, compared to her 2.4 hours during periods when the hospital was not full.
By the end of 2021, the national median boarding time was approaching the maximum recommended time of 3.4 hours. The 5% of hospitals with the highest occupancy had a median boarding time of 9 hours or more.
Nationally, the percentage of hospital beds occupied at any given time did not change significantly from 2020 to 2021. However, the number of emergency visits increased and boarding times worsened.
The researchers noted that their data source did not allow them to delve into the factors that contributed to high hospital occupancy, long boarding times, and emergency department patients being more likely to leave before being seen. increase.
However, they note that the strain is not evenly distributed throughout hospitals with emergency departments.
Boarding and overcrowding in the ED has been a serious problem for over 30 years. An incredible amount of work has been done in the emergency care community to make our care better, more accurate and faster using limited resources. But without more space and staff within hospitals, downstream advanced nursing facilities and across community settings, the crisis will continue. ”
Alex Janke, MD, MHS, first author
In addition to Janke, study authors are Edward R. Melnick, MD, MHS and Arjun K. Venkatesh, MD, MBA, MHS, from Yale University. “It’s not about his ED management,” says Venkatesh, an associate professor of emergency medicine at Yale University School of Medicine. “These are signs of overwhelmed resources and deeper problems in the healthcare system.”
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Michigan Medicine – University of Michigan
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