https://mailchi.mp/efa24453feeb/the-weekly-gist-july-22-2022?e=d1e747d2d8

We’ve been noticing a disconnect recently in our conversations with health system executives. When we share national data that shows that emergency department visits are still down substantially from pre-COVID levels, the reaction is often one of surprise.

As one CEO recently put it to us, “We’re seeing exactly the opposite. Our ED feels busier than ever.” It appears that, upon further examination, what’s going on is a shift in the mix of patients who are visiting the ED. The lower-acuity, urgent-care level cases do seem to have shifted away from traditional hospital settings toward virtual visits and urgent care centers. That’s good news from an overall cost of care perspective, but it means that hospital EDs are increasingly filled with sicker, more acute patients.

One sure sign the mix has shifted: many systems are now telling us that the percentage of ED visitors who end up getting admitted is rising. But staffing-driven capacity constraints mean that it’s taking longer to find an inpatient bed for those patients, or to discharge them from the ED to other settings (or back home)—so the average length of stay in the ED is going up.

On top of that, many EDs are now seeing an increase in psych patients, who stay longer and require greater staff attention. All of that, along with staff who are completely exhausted and demoralized after the pandemic, has combined to make many EDs feel swamped these days—despite what the national data are showing.