The Centers for Medicare & Medicaid Services (CMS) recently established a measure with the goal of capping emergency department (ED) durations at eight hours for adults aged 65 and older. However, findings published on June 30 reveal that 20% of elderly ED encounters in 2024 surpassed this imposed limit. This measure, part of the Age-Friendly Hospital initiative effective since Jan. 1, mandates hospitals to implement strategies aimed at enhancing senior patient care quality. These strategies include not only an eight-hour cap on ED stay duration but also a commitment to admitting patients within three hours of the admission decision.
Researchers from Boston’s Beth Israel Deaconess Medical Center delved into the data pertaining to roughly 17 million ED encounters involving seniors during 2017 and 2024 to assess the impact of the CMS measure. Notably, encounters surpassing the eight-hour mark rose from 12% in 2017 to 20% in 2024. The JAMA-published study reveals that academic hospitals observed a substantial increase in extended length of stay (LOS), from 19% in 2017 escalating to 30% in 2024. As for the three-hour admission goal, 22% of patients awaiting a bed spent over three hours in 2017, a figure that rose to 36% by 2024.
These prolonged ED stays pose significant risks to the wellness and care of senior patients. Extended time in the ED has been linked to higher risks of undesirable outcomes, like delirium and mortality. Additionally, it may lead to treatment delays, compromised patient privacy, and less than satisfactory patient experiences. The increase in ED LOS and boarding times not only intensify crowding in ED but are hallmarks of systemic healthcare dysfunction. More importantly, they put individual patients at risk. Therefore, addressing these issues is a critical step to ensure the health and welfare of both older adults and the healthcare systems that serve them.