Emergency Department Boarding: A Growing Concern in American Hospitals
In an ideal world, individuals in need of hospital care due to a medical emergency should be swiftly admitted to a hospital bed where they can receive the necessary care to aid in their recovery. However, a concerning trend known as “boarding” has been on the rise in emergency departments across the United States, leaving patients stranded in the ER for hours or even days until a suitable bed becomes available for them.
A recent national study has shed light on the escalating issue of boarding, which was already a growing problem before the onset of the COVID-19 pandemic. The study reveals that boarding has not only increased over the years but has reached alarming levels since mid-2020, remaining persistently high for four consecutive years. This spike is not limited to the usual winter months when viral infections peak, leading to a surge in emergency hospitalizations.
According to national hospital standards, patients should not board in an emergency department for more than four hours, as prolonged boarding poses safety risks and compromises the quality of care provided. However, data from the study, published in the journal Health Affairs by researchers from the University of Michigan Medical School and the Beth Israel Deaconess Medical Center, indicate that a significant proportion of patients have been experiencing extended wait times for a bed.
The study, which analyzed data from 46 million emergency visits that resulted in hospitalizations at the same facility, highlights the concerning trend of patients waiting four hours or more for a bed. The findings underscore the detrimental impact of long boarding times on patient safety, care delivery, and the overall functioning of emergency departments.
Dr. Alex Janke, the lead author of the study and an emergency physician at U-M Health, emphasized the urgency of addressing the issue of boarding to prevent overcrowding and long wait times in emergency departments. The sustained high levels of boarding observed over the past few years raise concerns about the healthcare system’s capacity to handle future crises, such as another pandemic.
The study also revealed disparities in boarding rates among different demographics, with the Northeast region exhibiting the highest rate of patients waiting for a bed for 24 hours or more. Furthermore, older adults, non-English or non-Spanish speakers, and Black patients were identified as groups experiencing a rapid increase in boarding during peak months.
Efforts to mitigate the impact of boarding and improve patient flow in emergency departments have been proposed, including measures to optimize inpatient capacity, streamline discharge processes, and enhance coordination between healthcare facilities. The Agency for Healthcare Research and Quality (AHRQ) has called for enhanced data sharing, regional collaboration, and innovative solutions to address the root causes of boarding.
As hospitals grapple with the challenges posed by boarding, institutions like U-M Health are implementing strategies to alleviate the strain on emergency departments. Initiatives such as short-stay units, home-based care options, and expanded inpatient facilities aim to enhance patient throughput and reduce boarding times.
Moving forward, comprehensive research and collaborative efforts are essential to develop sustainable solutions that address the complex issues contributing to boarding in emergency departments. By prioritizing patient safety, care quality, and system efficiency, healthcare providers can work towards ensuring timely access to hospital care for all individuals in need.
References:
– Alexander T. Janke et al, Hospital ‘Boarding’ Of Patients In The Emergency Department Increasingly Common, 2017–24, Health Affairs (2025). DOI: 10.1377/hlthaff.2024.01513
– University of Michigan (http://www.umich.edu/)
