A research letter at present in JAMA Community Open exhibits that, within the first yr of the COVID-19 pandemic, US hospitals coping with affected person surges held emergency-department (ED) sufferers in locations like hallways whereas awaiting an inpatient mattress for a median of 6.6 hours, far longer than the Joint Fee’s 4-hour commonplace.
The Joint Fee, a US-based healthcare accreditation group that units requirements for hospitals and different medical settings, has deemed ED boarding—or holding admitted sufferers within the ED, typically in hallways, as they look ahead to a mattress to open up—a affected person security danger.
Researchers from Yale College and the College of Michigan parsed aggregated month-to-month hospital knowledge by way of a voluntary peer benchmarking service provided by the digital well being document vendor Epic Techniques, Corp. from January 2020 to December 2021. Extra hospitals reported benchmarking knowledge because the pandemic progressed, rising from 1,289 in January 2020 to 1,769 by examine finish.
The workforce analyzed go to volumes, hospital beds, hospital occupancy, ED boarding time (time from hospital admission to switch to an inpatient unit), ED go to depend, and nationwide new each day COVID-19 infections.
Compromised affected person care, privateness
When hospital occupancy surpassed 85%, ED boarding exceeded the Joint Fee’s 4-hour commonplace 88.9% of the time. Median boarding time throughout months when hospital occupancy was increased than 85% was 6.58 hours, versus 2.42 in different pandemic months.
Amongst all hospitals, median ED boarding time was 2.0 hours (fifth to ninety fifth percentile, 0.93 to 7.88 hours) in January 2020, 1.58 hours (0.90 to three.51) in April 2020, and three.42 hours (1.27 to 9.14) in December 2021.
Median hospital occupancy was highest in January 2020 (69.6%; fifth to ninety fifth percentile, 44.3% to 69.6%), 48.7% (28.7% to 69.9%) in April 2020, and 65.8% (42.7% to 84.8%) in December 2021. All through 2020 and 2021, ED boarding elevated even when hospital occupancy did not rise above January 2020 ranges.
Restricted hospital assets have been related to extra affected person deaths, the examine authors famous.
“Downstream harms [of ED boarding] embrace elevated medical errors, compromises to affected person privateness, and elevated mortality,” they wrote. “Boarding is a key indicator of overwhelmed assets and could also be extra more likely to happen when hospital occupancy exceeds 85% to 90%.”
The researchers mentioned that ED boarding and crowding, which was an issue even earlier than the pandemic, could have turn into additional ingrained. “Future analysis ought to discover extra advanced measures like staffing variability and native outbreak burden,” they wrote.
“Coverage makers ought to tackle acute care system pressure in future pandemic waves and different disasters to keep away from additional hospital system capability pressure and unsafe affected person care situations.”