Emergency department boarding, the practice of holding admitted patients in the ED while they wait for an inpatient bed, remained a stubborn operational and clinical challenge for U.S. hospitals in 2025.
While many hospitals and health systems have made progress locally, national industry data indicate boarding is a growing challenge, signaling ongoing pressure on inpatient capacity and care delivery.
Here are four trends illustrating where ED boarding stands heading into 2026:
1. Boarding times worsened over the past several years: Boarding durations have climbed steadily in recent years, according to a large multihospital analysis published in Health Affairs earlier this year. The study, which examined 46 million ED visits leading to hospitalization at about 1,500 hospitals between 2017 and September 2024, found that a growing share of patients are waiting well beyond the four-hour safety standard for an inpatient bed.
Even outside traditional peak respiratory virus months, more than 25% of patients waited four hours or more for a bed in the last three years. During peak winter months, that figure rose to 35%. Cases in which patients waited 24 hours or longer — once rare — also became more common: By 2024, nearly 5% of patients admitted during peak months waited at least a full day for a bed, compared with about 2.6% in off-peak months. These trends underscore how boarding has shifted from an episodic seasonal issue to a persistent bottleneck in hospital operations.
2. ED volumes are rising and account for more hospital admissions: The importance of addressing boarding is amplified by growing demand for care. National data from Sg2 projects ED visits will rise 4% over the next decade to 125 million annually, with a growing share of those visits involving higher-acuity patients. A greater portion of hospital admissions now originate from the ED, national trends show.
At Portland-based Oregon Health & Science University, for example, about 40% of inpatient admissions in 2024 came through the ED — a significant increase over the past five years.
3. Vulnerable patients face disproportionate boarding: Certain patient populations are particularly affected by boarding. Children and individuals presenting with behavioral health conditions experience higher rates of prolonged waits in the ED for appropriate disposition.
Nearly 12% of pediatric visits to the ED for mental health conditions result in boarding lasting at least three days, with some states seeing far higher percentages than others, according to a study published in August in JAMA. This trend not only exacerbates access and quality issues for these vulnerable groups but also highlights the persistent dearth of inpatient and community‑based behavioral health resources.
4. Systems take action, though say broader policy change is needed: Some health systems saw measurable progress in reducing boarding in 2025. Atrium Health Wake Forest Baptist—High Point Medical Center in North Carolina implemented a 12-bed clinical decision unit and a six-bed transitional care unit, created a “right patient, right bed” initiative, and revised triage protocols — all contributing to a dramatic reduction in ED boarding hours. In June, the hospital reported zero boarders despite census levels higher than its historical seasonal norms.
Boston-based Mass General Brigham has focused on reducing inpatient length of stay, optimizing patient transfers to community hospitals, and expanding use of discharge lounges and auxiliary beds. These operational strategies have helped reduce ED pressure, particularly during virus season.
Still, leaders say sustainable progress requires broader reform. Experts point to a need for updated reimbursement models, public reporting of boarding metrics, and regional bed coordination systems. The Agency for Healthcare Research and Quality echoed these priorities in a March report, urging national action to address what many in the industry view as a structural patient safety crisis.
