Last year, the Centers for Medicare & Medicaid Services (CMS) released data that shows a concerning trend in Emergency Departments (EDs) across the United States. In short, the data indicates that Americans are spending more time in the emergency department than previous years, going from an average of 155 minutes spent in the ED to 160 minutes, or 2 hours and 40 minutes.

While this change may seem minor, the increase points to an alarming series of issues that are currently plaguing EDs across the country. It also continues an uncomfortable and potentially dangerous trend, as average visit time nationwide was just 143 minutes in 2020.

In this piece, we’re going to go over what the data says about time spent in EDs, how each state varies in this area, the possible causes for this increase, and what can be done to stop this trend in the future.

In order to collect this data, CMS took what they call “Timely and Effective Care” measurements from October 2021 to September 2022. These measurements, among other things, calculated exactly how much time each patient spent, on average, the ED.

This data reveals some startling information. For example, the shortest average time spent in an ED could be found in North Dakota, where patients spent an average of 1 hour and 28 minutes in the ED. The longest time spent on average in the ED was in the District of Columbia (DC), where patients spent a staggering 5 hours and 29 minutes. Wisconsin falls right in the middle of the pack with an average ED wait time of 2 hours and 26 minutes.

Several factors contribute to the escalating time spent in EDs. These include staffing shortages, increasing patient volumes, and worsening issues related to ED boarding.

To start, let’s discuss ongoing staffing shortages. The healthcare industry has been grappling with a persistent shortage of medical professionals, particularly in emergency departments. There are a few potential reasons for this; staffing levels went down during the pandemic, and while these levels are returning, the increased pressure on staff may have led some to leave the industry. It is possible that this has contributed to a vicious cycle in which people leave the industry due to pressure, which in turn applies more pressure to existing staff and encourages them to leave as well.

Next, patient volumes appear to be increasing. This has led to crowding and more patients being placed in hallways, which at least one study has found leads to “a considerable increase in bed-to-emergency physician and emergency physician-to-disposition time.”

“This resulted in a statistically significant increase in length-of-stay in the ED for patients placed in the hallway,” reads the study published in ACEP Now.

Finally, EDs are struggling with boarding, resulting in what some have called a crisis-level problem in patient care. The aforementioned overcrowding leads to patients being held in EDs for hours or even days until they can receive care, upping the amount of time spent in EDs and leading to worse outcomes for patients.

“In a new ACEP poll of 2,164 U.S. adults, 44% of respondents said they or a loved one experienced long waits in emergency departments, with 16% waiting 13 or more hours before being admitted or transferred,” reads a piece in U.S. News. “Almost half of adults surveyed said they would delay emergency care if they knew they could face boarding.”

There are some potential solutions here. With regards to staffing, hospitals can hire more staff and find ways to make the job more attractive to potential applicants. This can include factors like increasing pay, providing flexible scheduling options, offering childcare for workers, and more. As far as patient volumes and boarding are concerned, this issue is multifaceted, though ACEP has “suggested creating a regional dashboard of available beds that emergency departments can use when needing to place someone,” per U.S. News.

These changes require time and, crucially, money. But as the healthcare landscape continues to evolve, proactive measures are essential to mitigate the impact of these factors and improve the overall quality of emergency care in the United States.