2017 to 2024 saw more seniors with prolonged ED length of stay

The proportion of older adults with prolonged emergency department length of stay (LOS) and boarding times increased from 2017 to 2024, according to a research letter published online June 30 in JAMA Internal Medicine.

In a cross-sectional study, Adrian D. Haimovich, M.D., Ph.D., from the Beth Israel Deaconess Medical Center in Boston, and colleagues examined data from the Epic Cosmos health records database for January 2017 to December 2024, representing 295 million older adults and 78 million admissions. The authors sought to assess prolonged LOS and boarding times.

The researchers found that 12% of the 4,564,359 included emergency department patient encounters had an LOS greater than eight hours in 2017, increasing to 20% of 12,392,737 encounters by 2024. In academic hospitals, the increase was most pronounced, with the percentage of encounters with prolonged LOS increasing from 19 to 30%. During the same interval, the proportion of boarding patients with a bed request to admission time of more than three hours increased from 22 to 36% of all admissions. The increase was largest among academic hospitals (31 to 45%). Small annual increases were seen in both measures from 2017 to 2020 (LOS, 1.1%; boarding, 2.8%), followed by a sharp increase from 2020 to 2022 during the COVID-19 pandemic (LOS, 4.2%; boarding, 6.1%). Between 2022 and 2024, there was partial recovery observed (LOS, −1.7%; boarding, −3.2%).

“Worsening emergency department LOSs and boarding contribute to emergency department crowding, reflect systemic health care dysfunction, and, most importantly, harm individual patients,” the authors write.

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