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United States' Performance on Emergency Department Throughput, 2006 to 2016.

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Emergency department (ED) wait times and patients leaving without being seen improved nationally from 2006 to 2016. However, the discharge rate for the sickest patients within 8 hours decreased, potentially due to increased testing.

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Area of Science:

  • Health Services Research
  • Public Health
  • Emergency Medicine

Background:

  • US emergency departments (EDs) historically faced challenges with long wait times, extended visits, patient boarding, and high rates of patients leaving without treatment.
  • Assessing recent national trends in ED patient flow is crucial for understanding system performance and identifying areas for improvement.

Purpose of the Study:

  • To evaluate national trends in emergency department (ED) throughput between 2006 and 2016.
  • To analyze changes in patient wait times, visit lengths, boarding, and rates of leaving without being seen (LWBS).

Main Methods:

  • Retrospective cross-sectional analysis using data from the National Hospital Ambulatory Medical Care Survey (2006-2016).
  • Survey-weighted generalized linear models were employed to assess temporal changes in ED visit outcomes.
  • Key outcome variables included ED visit volume, physician wait times, visit duration, boarding duration, LWBS proportion, and timely treatment/disposition rates.

Main Results:

  • National ED visits increased from 119.2 to 145.6 million between 2006 and 2016.
  • Median wait time to see a physician decreased significantly, and the proportion of patients leaving without being seen declined.
  • While overall timeliness improved, a lower proportion of critically ill patients were discharged within 8 hours, contrasted by increased discharges for low-acuity patients.

Conclusions:

  • US emergency department performance demonstrated improvements in timeliness and reduced LWBS rates from 2006 to 2016.
  • A concerning trend of decreased timely discharge for the sickest patients was observed, possibly linked to increased diagnostic and consultative services.
  • Further research is warranted to address disparities in care for high-acuity patients within EDs.