Two Recent Studies Show High Abandonment, Boarding Rates in Emergency Departments

Sarasota, FL (WorkersCompensation.com) – Between increasing costs, short staffing, and high rates of violence and burnout in the work environment, healthcare is quickly hitting a breaking point. Emergency departments (ED) have some of the highest levels of burnout and violence, and according to two recent studies utilizing measures from the leading electronic medical record software company Epic Systems, some patients may ultimately feel the impact. 

Even prior the pandemic, the Joint Commission set the standard of patient boarding at less than 4 hours, as studies have shown an association between boarding time and outcomes, as well as errors. In the midst of the pandemic however, it was difficult to maintain a 4-hour threshold. Researchers from Yale University reviewed data from Epic records from January 2020 through December 2021 to determine annual visit and bed volumes against boarding times.

January 2020 had the highest occupancy rates, as well as the highest ED boarding times. The average occupancy rate in January 2020 was 69.6 percent, decreasing to 48.7 percent in April 2020, and increasing again in December 2021 to 65.8 percent.

The researchers found a correlation between occupancy rates and ED boarding times. When the occupancy rate was higher than 85 percent, the ED boarding rate increased beyond the 4-hour threshold. Additionally, across all hospitals they noted that throughout 2020 and 2021, boarding times increased even when the hospitals were not above the 85 percent mark. Those above the 85 percent occupancy rate averaged a 6.58 boarding time, compared to an average of 2.42 hours for those facilities with lower occupancy rates. For those under the 85 percent occupancy rate, the average boarding time was 2 hours in January 2020 but decreased to 1.58 hours in April the same year. In December 2021 however, the average boarding time for those hospitals increased again to 3.42 hours.

The Yale researchers performed a second analysis on the Epic data markers with a focus on patient abandonment in cases where the patient left without being evaluated from 2017 to 2021. In 2017, the average abandonment rate was only 1.1 percent with a range from .5 to 2.5 percent. By 2021, the abandonment rate increased to 2.1 percent, with a range from .6 to 4.6 percent. It is interesting to note that among the worst hospitals, 10 percent of ED patients left before receiving a medical evaluation in 2021. Among the same hospitals, in January 2020, the percentage was 4.4 percent, and in 2017 the abandonment rate was 4.3 percent.  

The researchers consider the abandonment rate as a failure to offer equitable access to acute care, and believe more research needs to be done to evaluate long wait times, which could be a contributor.  

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