A recent study by researchers from the University of Michigan Medical School and Beth Israel Deaconess Medical Center has shed light on the increasing rates of patients requiring hospitalization being held for extended periods in emergency departments. This is believed to contribute significantly to increasing boarding times, a trend that has reportedly intensified over the last four years.
The study, detailed in Health Affairs, examined data drawn from around 46 million emergency visits across 1,500 hospitals in all 50 states, leading to hospitalization between 2017 and September 2024. It indicated that this problematic trend of prolonged Emergency Department (ED) boarding was already escalating before being further amplified by the COVID-19 pandemic. The research demonstrates that boarding levels have sustained significant heights over the last four years – an observation that remains consistent beyond just peak viral seasons.
According to standards defined by Michigan Medicine in an August 4 news release, a patient should not be subjected to boarding for over four hours for the safeguarding of care quality and patient safety. Not only does excessive boarding jeopardize patient care, but it also holds major financial implications for healthcare systems. Case in point, in 2024, the financial challenges encountered by both Portland’s Oregon Health & Sciences University and San Diego’s Scripps Health were tied directly to ED overcrowding.
Several notable findings from the research included:
1. Over the last three years, during non-peak months, more than a quarter of patients had to endure a wait of four or more hours for a bed in the ED. This statistic shot up to 35% during winter.
2. A wait of 24 hours or more for a bed, once considered a rarity, became alarmingly commonplace by 2024, with nearly 5% of all patients admitted during the peak months and 2.6% during the off-peak months being subjected to these waiting times.
3. Even during months with the lowest boarding rates in 2024, the number of patients waiting four or more hours was higher than the worst periods from 2017 to 2019.
4. Prior to the pandemic, less than 5% of patients encountered waits of more than 12 hours, this number hardly ever drops below 5% nowadays, irrespective of the time of year.
5. January 2022 observed the highest boarding times with 40% of patients boarded in ED for over four hours and 6% for 24 hours or longer.
6. The Northeast held the record for the highest rate of boarding for 24 hours or more.
7. The boarding rates during peak months for patients aged 65 or older and those who primarily spoke a language other than English or Spanish, as well as Black patients, saw a significant surge.