Research on hospital “boarding” of sufferers in emergency departments reveals nationwide rise in proportion who wait greater than 4 hours for a hospital mattress; 5% of sufferers wait over 24 hours.
RT’s Three Key Takeaways:
- Boarding Instances Have Worsened: Since 2020, over 25% of admitted emergency sufferers in non-peak months—and as much as 40% in peak months—waited 4 or extra hours for a hospital mattress, far exceeding nationwide security pointers.
- Systemic Pressure and Disparities: The boarding disaster disproportionately impacts older adults, non-English audio system, and Black sufferers, with the Northeast displaying the very best charges of 24-hour waits, signaling systemic mismatches between emergency demand and hospital capability.
- Pressing Want for Reform: Consultants and federal businesses name for systemic modifications—together with discharge efficiencies, regional bed-sharing information, and options for psychological well being crises—to deal with sustained overcrowding and forestall well being system collapse in future crises.
An increasing number of People sick sufficient to require hospitalization discover themselves spending hours and even days in emergency departments till a mattress opens up for them, a brand new nationwide examine reveals.
The issue – known as “boarding” – had already elevated earlier than the COVID-19 pandemic started, the examine finds. Nevertheless it actually accelerated beginning in mid-2020 and has stayed excessive for 4 years – and never simply within the winter months when viral infections rise and result in extra emergency hospitalizations.
Within the final three years, greater than 25% of all sufferers who got here to a hospital’s emergency division throughout a non-peak month, and obtained admitted to the identical hospital, waited 4 hours or extra for a mattress. In the course of the winter months it was nearer to 35%.
Nationwide hospital requirements say that no affected person ought to board in an emergency division for greater than 4 hours, for security and care high quality causes.
A 24-hour or longer await a mattress was once uncommon. However the examine reveals that by 2024, almost 5% of all sufferers admitted to a hospital from its ED throughout the peak months of winter waited a full day for a mattress. In the course of the off-peak months, 2.6% waited that lengthy.
The examine, printed within the journal Well being Affairs by a group from the College of Michigan Medical College and the Beth Israel Deaconess Medical Heart in Boston, used information from 46 million emergency visits that led to hospitalizations on the identical hospital. The information got here from the digital well being file methods of 1,500 hospitals in all 50 states, from the beginning of 2017 by way of the top of September 2024.
“This development in lengthy boarding occasions for admitted sufferers is an important driver of crowded situations and lengthy wait occasions in emergency departments,” mentioned first creator Alex Janke, M.D., M.H.S., an emergency doctor at U-M Well being and member of the U-M Institute for Healthcare Coverage and Innovation.
“Lengthy boarding occasions improve affected person security dangers, and delay wanted care, whereas making it troublesome for emergency departments to see new sufferers as they arrive,” he added. “Sustained excessive ranges of boarding, as now we have seen over the previous three years, recommend the well being system is susceptible to collapse within the occasion of one other pandemic.”
By 2024, even within the months with the bottom charges of boarding sufferers, the proportion of sufferers who waited 4 or extra hours for a mattress was increased than it had been throughout the worst occasions of yr in 2017 to 2019.
And whereas lower than 5% of sufferers waited greater than 12 hours for a mattress even on the peak occasions in pre-COVID years, now it not often goes under 5% even on the lowest occasions of yr.
The height was January 2022, when 40% of sufferers boarded in an ED for greater than 4 hours, and 6% boarded for 24 hours or longer.
Whereas boarding has grown nationwide and in all affected person teams, the Northeast had the very best charge of boarding for twenty-four hours or extra. Additionally, boarding throughout peak months rose particularly rapidly for these aged 65 and older, these whose main language is one thing aside from English or Spanish, and Black sufferers.
“Our work highlights the necessity each to arrange for winter peaks and to deal with years-long mismatches between acute care calls for and accessible sources,” write Janke and his coauthors Laura G. Burke, and Adrian Haimovich.
They cite a report from an ED boarding summit held final fall by the Company for Healthcare Analysis and High quality, in response to a bipartisan letter from members of Congress calling on the federal authorities to deal with the difficulty.
AHRQ’s report notes that mismatch between emergency visits and inpatient capability, and administrative and monetary components, are the important thing drivers of ED boarding.
The report concludes that confirmed options for ED boarding embrace smoothing out surgical schedules throughout the week to permit extra speedy motion of ED sufferers to inpatient beds; streamlining discharges to earlier within the day and on weekends; utilizing discharge lounges; utilizing mattress managers; and offering different providers for sufferers experiencing psychological or behavioral well being emergencies.
The summit’s individuals known as for extra measurement and public reporting of ED boarding, extra sharing of knowledge about mattress availability inside areas, assist for rural hospitals together with telehealth consults and transferring sufferers needing higher-level care, and efforts to scale back the necessity for inpatient behavioral well being care.
AHRQ is an company of the federal Division of Well being and Human Serivces centered on enhancing the standard and security of healthcare for all People.
U-M Well being has been working to deal with the difficulty of ED boarding in its flagship College Hospital for years, even because the variety of sufferers looking for emergency care has risen. New short-stay models, home-based hospital-level care, and specialised suppliers within the triage space have all been added.
The opening of the 264-bed D. Dan and Betty Kahn Well being Care Pavilion later this yr will enable for extra inpatient area in College Hospital for sufferers admitted from the emergency division.
Prashant Mahajan, M.D., M.P.H., M.B.A., professor and chair of Emergency Medication at Michigan Medication, emphasised the necessity for extra research on boarding and associated points nationwide, to tell policymaking. “We’d like rigorous analysis, to raised perceive this downside and establish sustainable options,” mentioned Mahajan, who can be a member of IHPI.
The information for the brand new examine got here from Epic Cosmos, which swimming pools information from hospitals that use some of the frequent digital well being file methods.
Hospital ‘Boarding’ Of Sufferers within the Emergency Division More and more Widespread, 2017–24, Well being Affairs,DOI:10.1377/hlthaff.2024.01513
