Older Adults ED Stays Rise in US
Older Adults Face escalating Emergency Department Delays: A Growing Crisis
new research reveals a notable and concerning rise in prolonged emergency department (ED) stays and boarding times for older adults across the United States, with academic hospitals bearing the brunt of this escalating challenge.
A complete study analyzing millions of patient admissions has found that the proportion of older adults experiencing extended waits in emergency departments has climbed substantially between 2017 and 2024.This trend,notably pronounced in academic medical centers,signals a deepening strain on healthcare systems and raises critical questions about patient care and system efficiency.
The Scope of the Problem: Extended Stays and Boarding
The study, which examined data from 1,633 U.S. hospitals and a staggering 78 million admissions, focused on patients aged 65 and older. Researchers meticulously tracked two key indicators of ED inefficiency:
Extended ED Length of Stay (LOS): Defined as remaining in the emergency department for more than 8 hours. Boarding Time: Referring to patients who are admitted to the hospital but remain in the ED awaiting an inpatient bed, also exceeding 3 hours.
The findings paint a stark picture of worsening conditions. From 2017 to 2024,the percentage of older adults experiencing ED stays longer than 8 hours more than doubled,rising from 12% to 20%. Similarly,boarding delays saw a dramatic increase,climbing from 22% to 36% over the same period.
academic hospitals at the forefront of the Crisis
Academic hospitals, often serving as tertiary care centers and teaching institutions, demonstrated the most significant deterioration in ED performance for older patients. These facilities witnessed an increase in ED LOS exceeding 8 hours from 19% in 2017 to 30% in 2024. boarding times in academic EDs also surged, escalating from 31% to 45% during the studyS timeframe.
Unpacking the Trends: A Pre- and Post-Pandemic Analysis
The research further delved into the temporal patterns of these delays, revealing a critical inflection point coinciding with the COVID-19 pandemic.
Pre-Pandemic Growth (2017-2020): Between 2017 and 2020, modest annual increases were observed in ED LOS and boarding time, at 1.1% and 2.8% respectively. This indicated a gradual, underlying pressure on emergency services.
Pandemic Acceleration (2020-2022): The onset of the COVID-19 pandemic triggered a sharp acceleration in these delays. From 2020 to 2022, ED LOS and boarding time saw considerable annual increases of 4.2% and 6.1%, respectively. This period likely reflects the overwhelming surge in patient volumes, staffing challenges, and the implementation of infection control measures that impacted patient flow.
Post-Pandemic Stabilization and Partial Decline (2022-2024): Following the peak of the pandemic, the data indicates a partial reversal of the sharpest increases, with modest annual declines of -1.7% in ED LOS and -3.2% in boarding time observed between 2022 and 2024. However, these declines have not erased the significant gains in delays experienced during the pandemic, leaving overall wait times considerably higher than pre-pandemic levels.
The Human and Systemic Impact
The implications of these prolonged ED stays and boarding times are far-reaching and deeply concerning. As the study’s authors aptly stated, “Worsening ED LOSs and boarding contribute to ED crowding, reflect systemic health care dysfunction, and, most importantly, harm individual patients.”
These delays can lead to:
Delayed Diagnosis and Treatment: Critical time is lost for patients requiring urgent medical attention.
Increased Patient acuity: Patients may deteriorate while waiting for care or an inpatient bed.
Reduced Patient Satisfaction: Long waits erode trust and confidence in the healthcare system.
Staff Burnout: Overcrowded and inefficient EDs place immense pressure on healthcare professionals.
Compromised Quality of Care: The ability to provide timely and effective care is diminished.
“Addressing these trends is critical to safeguarding both the health of older adults and the health systems caring for them,” the authors emphasized, highlighting the urgent need for systemic solutions.
Understanding the Study’s Nuances and Limitations
the study,led by Adrian D. haim