# Degree of Compliance of Hospital Emergency Departments With the Recommended Standards and Their Evolution During the SARS-CoV-2 Pandemic

## TL;DR

This study analyzed how well Spanish hospital emergency departments followed care time standards and how these changed during the SARS-CoV-2 pandemic.

## Contribution

The study provides new insights into ED compliance with care time standards and their evolution during the pandemic in Spain.

## Key findings

- ED lengths of stay varied significantly by triage level, with the longest times for Levels 1 and 2.
- In 2021, all hospitals showed statistically significant increases in dwell times for triage Levels 2–5.
- Longer waiting times at triage Levels 3, 4, and 5 were associated with higher mortality risk.

## Abstract

Aim: To analyse the degree of compliance of the care times of hospital emergency departments (EDs) in Spain with the recommended standards and their evolution during the SARS-CoV-2 pandemic.

Design and Methods: An observational, correlational, cross-sectional and retrospective study was carried out. All adult patients attended in the EDs of 8 Spanish public hospitals from 2018 to 2021 were consecutively included. The main variables were time spent in the ED, time to triage, waiting time until the start of care, triage level, classified according to the Spanish Triage System and year of care. Other sociodemographic variables were collected, in addition to discharge destination. For each triage level, a negative binomial regression model was performed, adjusted for year, hospital and waiting times. The analysis was performed with R 4.2.2 software.

Results: A total of 2,282,555 patients were included; ED lengths of stay varied according to triage levels: Level 1, 21.6 h; Level 2, 26.3 h; Level 3, 22.2 h; Level 4, 8.1 h and Level 5, 10.3 h. Statistically significant differences were detected only in 2021, in all hospitals and from priority Level 2–5. An increase in dwell times was observed in all hospitals, with longer dwell times in high complexity hospitals. Longer waiting times at triage Levels 3, 4 and 5 presented a higher risk of mortality. The percentage of patients leaving the ED was high (3.6%).

Conclusions: The degree of compliance with ED care times according to recommended standards was low. The dropout rate, waiting times for initial triage and ED attendance were higher than desired. The SARS-CoV-2 pandemic changed the pattern of ED visits, decreasing the frequentation of patients, but did not decrease the length of stay in the ED. This pattern normalised the following year.