Why nearly half of Americans avoid emergency care: New ACEP findings

A significant proportion of Americans indicate they would delay or avoid emergency care altogether due to concerns they would be held in hospital emergency departments for extended periods of time while waiting for an inpatient bed to open up, according to new survey findings.

Between Sept. 9-11, more than 2,100 U.S. adults participated in a poll conducted by the American College of Emergency Physicians and Morning Consult. Overall, 43 percent of respondents said they would delay or avoid going to the emergency department if they knew they or a loved one might face a long wait before being admitted or transferred. Nearly the same proportion said they or a loved one have experienced long ED wait times.

Of the 950 respondents who indicated they've experienced a long wait time, 58 percent said the average wait was between four and 12 hours. Sixteen percent waited at least 13 hours. 

"Boarding in the emergency department is a national public health crisis," Aisha Terry, MD, president of the ACEP, said in a statement about the findings. "There's no question these excessive delays are harmful to patients waiting to be transferred and those waiting to be seen. It should alarm regulators, policymakers, and health system leaders that people would delay or avoid emergency care and risk their health because of these systemic hospital bottlenecks." 

The Joint Commission lists boarding — which often means patients awaiting admission are held in hallways — a patient safety risk that shouldn't exceed four hours. While not a new issue, healthcare groups warned last November that staffing and related pressures from the COVID-19 pandemic brought ED boarding to a crisis level. In a letter sent to President Joe Biden last fall, dozens of medical groups including the ACEP warned of the safety and quality risks associated with boarding, citing anonymous reports from emergency physicians who said patients have died while awaiting treatment because of the issue.

"Patients in need of intensive care may board for hours in ED beds not set up for the extra monitoring they need. Those in mental health crises, often children or adolescents, board for months in chaotic EDs while waiting for a psychiatric inpatient bed to open anywhere. Boarding doesn’t just impact those waiting to receive care elsewhere. When ED beds are already filled with boarded patients, other patients are decompensating and, in some cases, dying while in ED waiting rooms during their tenth, eleventh, or even twelfth hour of waiting to be seen by a physician," the groups wrote in their letter.

Staffing issues across the entire healthcare sector, including skilled nursing homes and other long-term care settings, have been a key factor in hospitals' inability to discharge patients in a timely manner and free up rooms for ED patients who need them. 

The ACEP held a summit in September that convened stakeholders from hospitals, nursing homes, policy makers, EMS, as well as patient and medical groups to discuss the national boarding challenge and identify collaboration opportunities to develop solutions. 


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