Capacity: It’s a word that comes up in nearly every conversation with hospital and health system leaders today. As the nation’s population ages and the healthcare sector faces a wave of workforce retirements, capacity has become a defining operational challenge. Inpatient days are rising, emergency department volumes are climbing and discharge delays continue to disrupt patient flow.
Here are five trends that spotlight hospital capacity stressors, and how hospitals are adapting:
- Inpatient utilization is climbing: By 2034, annual inpatient days are projected to reach 170 million, a 9% increase from current levels, according to Vizient subsidiary Sg2’s 2024 “Impact of Change” report. High-acuity inpatient days — typically the most resource-intensive — are projected to rise 13%, driven by the nation’s aging population and rising burden of comorbid disease.
- Emergency department volumes keep rising: ED visits are set to rise 4% to 125 million annually within the next decade, with the share of emergent visits on the rise, according to the Sg2 report. This reflects a broader shift in hospitals’ case mix: Increasingly, they are caring for higher shares of patients with complex medical needs. In the U.S., utilization rates of emergency services are highest among homeless individuals, nursing home residents and infants under the age of 1, according to an analysis of national data from the Emergency Department Benchmarking Association.
Across the U.S., systems are also seeing ED admissions account for a growing share of total hospitalizations. At Portland-based Oregon Health & Science University, for example, about 40% of inpatient admissions in 2024 came from the ED — a significant increase over the past five years.
- Boarding remains a persistent pain point: ED boarding — the practice of holding patients in the ED, often in hallways when they require admission but no inpatient beds are available — remains a major challenge at hospitals across the country. While average boarding times dropped from 182 minutes in 2022 to 110 in 2023, the issue remains especially pronounced in high-volume EDs. The majority of emergency medicine physicians say they have experienced boarding times in their facilities exceeding 24 hours, with some facilities seeing boarding numbers that frequently approach or exceed their total number of ED beds.
Across the industry, awareness is growing around the true drivers of ED boarding, including reduced inpatient bed capacity, misaligned financial incentives that prioritize high-revenue surgical cases and burdensome payer requirements that delay discharges. For years, efforts to ease ED strain focused largely on patient education and redirecting low-acuity patients to urgent care. While well-intentioned, emergency medicine experts say these approaches are flawed because they are solely focused on ED input factors. Hospital-led solutions, such as smoothing surgical schedules and streamlining discharge processes, have shown promise, but experts say policy changes are needed to achieve significant progress. This includes revised payment incentives, greater access to behavioral health services and requiring public reporting of boarding metrics.
- Discharge delays undercut length of stay progress: Average length of stay has improved modestly, falling 2% between 2022 and 2023, according to the Sg2 report. However, the gains are fragile as hospitals must grapple with discharge delays. A chronic lack of space in nursing homes, behavioral health facilities and rehabilitation centers often leaves hospitals unable to transition patients who no longer require inpatient-level care.
At San Diego-based Scripps Health, for example, roughly 35,000 patients annually remain hospitalized after they’re medically cleared — a figure that has more than doubled in three years. These types of delays drive up inpatient days and create downstream effects across the entire care continuum, including ED boarding and postponed elective cases.
- Health systems tackle capacity strain from all angles: Health systems are investing in a wide range of efforts to ease capacity strain. Many are expanding outpatient access points for older adults and patients with chronic conditions to improve disease management and reduce avoidable hospital visits.
Apart from expanding physical access points, hospitals are largely focused on improving operational efficiency to maximize existing capacity. Centralized command centers have emerged as a key strategy, offering staff real-time visibility into bed status, patient flow and staffing resources. These hubs enable staff to quickly identify open beds and minimize discharge delays. Engaging clinical teams in length-of-stay improvement work is another critical lever leaders are pulling to enhance patient flow.
