Boarding in US Academic Emergency Departments During the COVID-19 Pandemic

Abstract

Study objective: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Figure

Total boarding hours and LWBS or SAL per month, with monthly incidence of COVID-19 per 100,000 people. Box-and-whisker plots show, for each month, median (horizontal bar), IQR (box), 1.5∗IQR (whisker), and outliers (points). Red points indicate unadjusted monthly mean. The number of participating EDs/hospitals varies over time; 43 EDs are included from January 2019 to August 2020, 40 EDs are included from September 2020 to February 2021, 39 EDs are included from March 2021 to June 2021, and 38 EDs are included from July 2021 to December 2021.