More patients who require hospitalization are waiting hours or days in emergency departments for a bed to open, and the trend has grown worse the past four years, researchers at the University of Michigan Medical School in Ann Arbor and the Beth Israel Deaconess Medical Center in Boston found.
The study, published in June in Health Affairs, used data from 46 million emergency visits that led to hospitalizations from EHR systems at 1,500 hospitals from all 50 states. Analyzed hospitalizations took place from 2017 to September 2024.
The boarding problem was already worsening before COVID-19 pandemic, but it has remained high for the last four years, and not just during peak viral seasons. National hospital standards indicate a patient should not board for more than four hours for safety and care quality reasons, according to an Aug. 4 Michigan Medicine news release.
Boarding also leads to steep financial implications for health systems. In 2024, at least two health systems — Portland-based Oregon Health & Sciences University and San Diego-based Scripps Health — linked financial challenges to ED overcrowding.
Here are seven study findings:
1. In the last three years, more than 25% of patients who appeared at an ED during a non-peak month waited four hours or more for a bed. During the winter months, that number rose to 35%.
2. Waiting 24 hours or longer for a bed used to be rare, but by 2024, nearly 5% of all patients admitted to the hospital during peak months waited 24 hours for a bed. In off-peak months, that number was 2.6%.
3. Even in months with the lowest rates of boarding patients in 2024, the percentage of patients who waited four or more hours for a bed was higher than during the worst times in 2017 to 2019.
4. Before the pandemic, fewer than 5% of patients waited more than 12 hours for a bed even during peak times, now it rarely goes below 5% even at the lowest times of year, the study said.
5. January 2022 had the worst boarding times: 40% of patients boarded in the ED for more than four hours and 6% boarded for 24 hours or longer.
6. The Northeast had the highest rate of boarding for 24 hours or more.
7. Boarding during peak months rose quickly for patients 65 and older, those whose primary language was something other than English or Spanish, and Black patients.
