Emergency department (ED) wait times are on the rise across the United States, a troubling trend that reflects deeper systemic challenges in the nation’s health care systems. According to data from the Centers for Medicare & Medicaid Services, the median time spent in the ED has increased from 2 hours and 15 minutes in 2018 to 2 hours and 40 minutes in recent years. Data from the American Journal of Emergency Medicine shows this increase comes even as ED visits experienced a 12 percent drop in volume from 2019 through the first quarter of 2022.
The paradox of declining volume and increasing wait times
The decline in ED volume during the pandemic led to a contraction in staffing levels, as hospitals laid off workers in response to fewer patients. However, as volumes began to rebound in 2021, the tight labor market complicated rehiring efforts, leading many hospitals to rely more on temporary and part-time staff.
These staffing challenges have been made worse by a loss in efficiency and best practices since the pandemic’s height. In 2024, although ED volumes are nearly back to pre-pandemic levels, many hospitals continue struggling to regain operational efficiencies.
Impact of point solutions
In an attempt to address specific inefficiencies, many hospitals have turned to digital health point solutions—software and applications targeted at particular aspects of various workflows such as patient intake, triage, and data management. While these tools claim to improve certain functions, their isolated implementation often results in fragmented systems that do not communicate well with each other, leading to data silos and even greater clinical inefficiencies.
In fact, within the U.S. health system as a whole, McKinsey and Company reports that productivity has declined 13 percent since 2001, despite a rise in technology adoption. At the crux of this dilemma is the fact that growth in health care is almost exclusively reliant on workforce expansion, as opposed to getting to the root of the problem and addressing labor productivity. This rise in technology spending coincides with the adoption of electronic health records (EHRs). EHRs are great for revenue cycle management and patient documentation, but we cannot assume that the EHR is the panacea for clinical and administrative inefficiency. There is enormous potential to improve productivity by integrating automation technologies and artificial intelligence (AI) to address inefficiencies with administrative tasks and to improve care delivery.
Considering the Mercer projects, the U.S. will be short over 3.2 million health care workers by 2026; relying solely on workforce expansion is not only the wrong move, it will be nearly impossible.
A call for comprehensive solutions and systemic reform
To address these critical challenges, health care administrators need to examine care delivery across the entire organization and consider solutions that directly improve both ED throughput and workflow changes across the system that improve capacity allocations. Health organizations must adopt an integrated approach to digital transformation, ensuring that systems work seamlessly together throughout the entire patient care journey—across all care modalities and locations. This integration enhances data sharing, reduces task redundancy, and improves overall efficiency and labor productivity within health systems as a whole.
There is a big opportunity for technology solutions that can simultaneously automate ED administrative processes while also alleviating capacity burdens by enabling low-acuity patients to receive care in more appropriate settings such as telehealth, primary care, and urgent care centers. Over the last decade, we’ve seen a rise in AI-powered chatbots and symptom-checking apps as health care consumerism and self-service is front and center. My health tech company works with digital-first provider organizations that are using conversational AI chatbots to automate intake and provide patients with a virtual symptom checker to direct them to the appropriate place to seek care. During the pandemic, some of these organizations reduced call center volume by 30 percent by efficiently directing patients to appropriate resources. AI can also initiate virtual visits for conditions that do not require in-person care, such as urinary tract infections and upper respiratory infections, using expert systems or asynchronous telemedicine. With good systems integration, these tools enable providers to treat patients much faster, ensuring that in-person care and hospital beds are available for patients in the most critical conditions. They also meet the growing patient demand for convenient, digital care.
Beyond checking for symptoms, these AI-based tools can serve as digital assistants to physicians, virtually collecting basic health information before a patient even sees the physician and then serving as a valuable triage tool to direct patients to the appropriate care setting. By doing so, providers can reduce documentation time, enabling patients to avoid long wait times in the ED and receive faster care, minimizing patient elopement, and reducing roomed-to-discharge times to free up beds for patients who need them the most.
As ED wait times continue to rise, it becomes increasingly clear that addressing these delays requires more than isolated fixes. A comprehensive, system-wide approach that includes better integration of technology, improved staffing strategies, and reinstated operational efficiencies is essential. Such reforms will not only reduce wait times but also improve the quality of care for millions of Americans who rely on emergency departments each year. As the health care system continues to recover and adapt post-pandemic, these changes will be critical in meeting the evolving needs of patients and providers.
Aiden Feng is a physician executive.
