Older adults are waiting even longer in emergency departments, study finds
Boston physicians announced this week that the average length of stay and boarding times for people over the age of 65 had significantly increased between 2017 and 2024.
The trends, the doctors note, indicate systemic challenges in hospitals around the country. They also signal an increasingly frustrating and potentially dangerous experience for patients.
"Worsening emergency department lengths of stay and boarding contribute to emergency department crowding, reflect systemic health care dysfunction, and, most importantly, harm individual patients," they explained.
To reach these conclusions, the doctors used data from 1,633 hospitals and 295 million patients. They analyzed emergency department encounters that were recorded between January 2017 and December 2024.
They focused on the proportion of older adults with a length of stay over eight hours and the proportion of admitted patients waiting more than three hours between when they requested a bed and their admission.
In 2017, 12 percent of more than 4 million emergency department encounters involved a length of stay over eight hours. By last year, that percentage had surged to 20 percent of more than 12 million encounters.
During the same period, encounters involving boarding times over three hours increased from 22 percent of 1.8 million encounters in 2017 to 36 percent of 4.3 million encounters in 2024. The largest increase was reported in academic hospitals, with boarding times over three hours rising from 31 percent in 2017 to 45 percent in 2024.
Before Covid, there were small spikes observed in both metrics that were followed by sharper rises during the pandemic's peak. From 2022 to 2024, as more Americans were vaccinated against Covid, both trends slightly declined.
The authors suggested that these increases may be driven by several factors, such as increased patient complexity, growing demand, and ongoing staffing and resource shortages.
Health care workforce shortages are projected to rise across the U.S. in the coming years, with demand far outpacing supply in some specialties, according to a report from the non-profit National Institute for Health Care Management Foundation. There could be a shortage of as many as 100,000 critical health care workers by 2028, the consulting firm Mercer warned.
In recent years, many nurses and doctors have reported feeling burnt out — although burnout rates reportedly aren't as high as they were in the first years of Covid, a study out of Stanford Medicine found.
But, emergency room overcrowding is nothing new. A 2022 survey by the American College of Emergency Physicians found that 97 percent of emergency room doctors said they experienced patient boarding times of more than 24 hours, and more than a quarter said patients were forced to stay in the emergency room for more than two weeks before getting a hospital bed.
Solutions to this issue aren't yet ironclad. To attempt to fix it, doctors have suggested only treating patients with emergencies, expanding hospital capacity, changing admitting patterns, and making sure patients don't end up in the ER in the first place through enhanced disease prevention. One program started in 2020 set up hospital beds at patients' homes.
Without established solutions, the outcomes can be negative for older adults, who make up more than 20 percent of emergency department visits, according to Centers for Disease Control and Prevention data from 2022.
"You really don't want an 85-year-old or older patient lingering and sort of stranded in the emergency department for hours and days on end," Dr. Ula Hwang, medical director of geriatric emergency medicine at NYU Langone Health in New York City, told the American Heart Association in May. "It's been shown that if you're an older adult and you board in the emergency department overnight, you are at greater risk for developing delirium, even potentially having an inpatient mortality."
The researchers noted that a new measure effective this year limits stays to under eight hours and admissions to within three hours.
"Addressing these trends is critical to safeguarding both the health of older adults and the health systems caring for them,' the authors concluded.
The findings were announced in a research letter published on Monday in the journal JAMA Internal Medicine.
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