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CIDRAP-Emergency room patients often wait 4 hours or more for a hospital bed—some more than a day

Lance

MPH, CSP & CIT Retired, CHMM Emeritus
https://www.cidrap.umn.edu/public-h...it-4-hours-or-more-hospital-bed-some-more-day

Emergency room patients often wait 4 hours or more for a hospital bed—some more than a day



Meghan Holohan


14 minutes ago.

Public Health
On the medical drama “The Pitt,” patients often spend hours in the emergency department waiting for a bed in the hospital, a detail that makes the show feel realistic. That practice, what’s known as boarding, remains a serious problem for hospitals across the United States.

A paper this week in JAMA found that, across 17 US healthcare systems, which included 56 emergency departments, more than half of patients who need to be admitted to the hospital wait four hours or more for an in-patient bed—with some people standing by for 24 hours or longer.

“Risk concentrates at these moments where one clinical team hands a patient to another. Emergency and in-patient teams work on different clocks, and they're doing this under resource constraints,” Alex Janke, MD, MHS, an assistant professor of emergency medicine at the University of Michigan Medical School and first author of the paper, said in a university press release.

“What our data show is that some hospitals consistently manage that transition in under four hours, and others take more than a day, which suggests it comes down to how a hospital organizes the work, not just how full it is.”

Boarding can last anywhere from 4 to 24 hours


The researchers examined electronic health record data from more than 3 million adult emergency department visits from June 1, 2024, to May 31, 2025. Almost a half million people, 492,135 needed to be admitted for general medical care—which includes geriatrics, internal medicine, or family medicine—and of those patients, 263,666 (53.6%) waited at least four hours for a bed.

Risk concentrates at these moments where one clinical team hands a patient to another.

Alex Janke, MD, MHS

Among the 492,135 patient eventually admitted to general medical care, 84,936 (17.3%) experienced a four-hour or longer delay in being transferred without first receiving care as an inpatient, with 22,905 (4.7%) seeing at least a 12-hour holdup without such care, and 4,497 (0.9%) lingering in the emergency department for 24 hours or more without inpatient management before being moved. Of those patients with delayed inpatient care, 54% to 55% were 65 or older.

“Delays in the transition from emergency care to inpatient management can be dangerous,” Janke said.

Patients who waited 12 or 24 hours for a hospital bed often visited emergency departments in hospitals that treated more patients with Medicaid and trained new doctors. Being 65 or older and covered by Medicare and having more serious illness also meant a longer wait-time for patients needing a hospital bed.

“Hospital boarding in emergency departments is endemic across the US right now. Health systems must have a plan for resourcing clinical teams to keep patients safe while they board.” Janke said. “This is especially important for older patients, those with multiple chronic conditions, and those taking high-risk medications.”
 
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