An alarming number of Americans are spending extended hours—sometimes even days—in emergency rooms (ERs) as they await available hospital beds, according to a recent study published in Health Affairs.
The study reveals that over 25% of patients requiring hospital admission are subjected to “boarding,” where they remain confined in ER hallways or makeshift spaces for four or more hours before transfer to an inpatient bed. This figure climbs to 35% during winter months when infectious disease surges drive higher emergency admissions.
More concerningly, nearly 5% of admitted patients during peak winter seasons endure waits of a full 24 hours or longer, compared to nearly 3% during off-peak periods.
“This increase in prolonged boarding for admitted patients is the primary contributor to overcrowding and lengthy ER wait times,” said Dr. Alex Janke, lead author of the study and emergency physician at the University of Michigan.
Dr. Janke emphasized the risks, noting, “Extended boarding times compromise patient safety, delay essential treatments, and hinder emergency departments’ capacity to manage incoming patients. The persistently high boarding rates observed over the past three years indicate our healthcare system may be vulnerable to collapse during future public health crises.”
Researchers analyzed data from 1,500 hospitals across all 50 states, covering the years 2017 through September 2024. While boarding trends were already rising before the COVID-19 pandemic, they surged sharply starting mid-2020 and have remained elevated.
The peak occurred in January 2022, with 40% of admitted patients boarded for over four hours and 6% for 24 hours or more. By 2024, average wait times surpassed those seen during the worst periods between 2017 and 2019.
Today, at least 5% of patients consistently wait over 12 hours for a hospital bed—a scenario that was previously rare.
The phenomenon of boarding has increased nationwide and across all patient demographics, with the Northeast region exhibiting the highest rates of 24-hour or longer boarding.
The study concludes with a call to action: “Our findings highlight the urgent need for healthcare systems to prepare for seasonal surges and address the chronic imbalance between acute care demand and available hospital resources.”
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