Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania.
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Emerg Med. 2023 Sep;82(3):247-254. doi: 10.1016/j.annemergmed.2022.12.004. Epub 2023 Jan 19.
The first 2 years of the COVID-19 pandemic brought substantial and dynamic changes to emergency department volumes and throughput. The objective of this study was to describe changes in ED boarding among US academic EDs across the duration of the COVID-19 pandemic.
We conducted a retrospective analysis of monthly data collected from a convenience sample of academic departments of emergency medicine. The study period was from January 2019 to December 2021. The primary outcome was total boarding hours, and secondary outcomes included patient volume stratified by ED disposition. We used multivariable linear panel regression models with fixed effects for individual EDs to estimate adjusted means for 3-month quarters.
Of the 73 academic departments of emergency medicine contacted, 34 (46.6%) participated, comprising 43 individual EDs in 25 states. The adjusted mean total boarding hours per month significantly decreased during the second quarter of 2020 (4,449 hours; 95% confidence interval [CI] 3,189 to 5,710) compared to the first quarter of 2019 (8,521 hours; 95% CI 7,845 to 9,197). Beginning in the second quarter of 2021, total boarding hours significantly increased beyond pre-pandemic levels, peaking during the fourth quarter of 2021 (12,127 hours; 95% CI 10,925 to 13,328).
A sustained and considerable increase in boarding observed in selected US academic EDs during later phases of the COVID-19 pandemic may reflect ongoing stresses to the health care system, with potential consequences for patient outcomes as well as clinician well-being.
COVID-19 大流行的头 2 年给急诊科的量和吞吐量带来了实质性和动态的变化。本研究的目的是描述 COVID-19 大流行期间美国学术急诊科的 ED 住院时间的变化。
我们对从一个便利的急诊医学学术部门样本中收集的每月数据进行了回顾性分析。研究期间为 2019 年 1 月至 2021 年 12 月。主要结局是总住院时间，次要结局包括按急诊科处置情况分层的患者量。我们使用具有个体急诊科固定效应的多变量线性面板回归模型来估计 3 个月季度的调整平均值。
在联系的 73 个急诊医学学术部门中，有 34 个（46.6%）参与了研究，包括 25 个州的 43 个独立急诊科。与 2019 年第一季度（8521 小时；95%置信区间[CI] 7845 至 9197）相比，2020 年第二季度的调整后每月平均总住院时间显著减少（4449 小时；95%CI 3189 至 5710）。从 2021 年第二季度开始，总住院时间显著超过大流行前水平，在 2021 年第四季度达到峰值（12127 小时；95%CI 10925 至 13328）。
在 COVID-19 大流行后期，在美国选定的学术急诊科观察到持续且相当大的住院人数增加，这可能反映了医疗保健系统的持续压力，对患者结局以及临床医生的幸福感都可能产生潜在影响。
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