Increasing Wait Times for Emergency Hospitalization
They should be in a hospital bed, receiving care to aid in their recovery from a medical emergency.
However, a concerning trend is emerging where more and more Americans requiring hospitalization find themselves spending extended hours, sometimes days, in emergency departments while waiting for an available bed, as a recent national study reveals.
Known as “boarding,” this issue has been on the rise even before the onset of the COVID-19 pandemic. The study indicates a significant escalation in boarding cases starting in mid-2020 and has remained high for the past four years, regardless of seasonal fluctuations in emergency hospitalizations.
In the last three years, over 25% of patients admitted to a hospital from the emergency department during non-peak months had to wait four hours or more for a bed. This percentage increased to nearly 35% during winter months. National hospital standards recommend that no patient should board in an emergency department for more than four hours due to safety and care quality concerns.
The study, published in Health Affairs by researchers from the University of Michigan Medical School and the Beth Israel Deaconess Medical Center, analyzed data from 46 million emergency visits leading to hospitalizations at the same facility. The data spanned from the start of 2017 to the end of September 2024, capturing a comprehensive view of this concerning trend.
Dr. Alex Janke, the lead author of the study, expressed concerns about the implications of prolonged boarding times on patient safety and care quality. He highlighted the impact of long boarding times on delaying necessary care and impeding emergency departments’ ability to accommodate new patients promptly.
By 2024, the study noted a significant increase in patients waiting for extended periods for a bed, even during non-peak months. The prevalence of patients waiting over 12 hours for a bed, once rare, has become more common, with a substantial peak in January 2022 where 40% of patients experienced prolonged boarding.
While boarding affects patients nationwide, the Northeast region exhibited the highest rate of cases where patients waited 24 hours or more for a bed. Additionally, boarding rates during peak months rose notably for older adults, non-English or non-Spanish speakers, and Black patients.
The study emphasizes the urgent need to address the mismatch between acute care demands and available resources in healthcare settings. It calls for proactive measures to manage emergency department boarding effectively and enhance patient care delivery.
Efforts to mitigate boarding challenges include optimizing surgical schedules, streamlining discharge processes, leveraging discharge lounges, employing bed managers, and offering alternative services for patients with mental health emergencies. These strategies aim to alleviate boarding issues and enhance the overall patient experience in emergency departments.
As the healthcare system grapples with the implications of prolonged boarding, stakeholders are urged to collaborate on innovative solutions to enhance patient care and address the systemic challenges contributing to this concerning trend.
