Pre-to-post COVID-19 pandemic trends in time from emergency department arrival to inpatient floor arrival: Door to floor time.

Boarding of admitted patients in the Emergency Department (ED) changes both the setting and teams providing care during the initial phase of admissions. We measured the waiting time from ED door arrival to inpatient floor arrival for 17,944 admissions to internal medicine services over a 5-year period from 2018 to 2023 and propose this as a metric for the total delay in care associated with ED boarding, termed "Door to Floor" (DTF) time. We find a sustained increase as well as significant seasonal and day-of-the-week variation in DTF times. DTF times increased over weekends and peaked on Monday suggesting a contribution from reduced number of discharges on weekends. The majority of DTF time arises from time in the ED after the disposition decision is made. Determining patterns in boarding time as well as of which phases of care contribute to boarding time can be used inform and track interventions.