Waiting for a bed, but not for care: Emergency department boarding study finds wide variation in handoffs
Every day across the country, patients wait hours or days in clogged emergency departments for a hospital bed to open—a well-known crisis called boarding. Now, a new study published in JAMA looks more closely at what happens after doctors decide patients are sick enough to be admitted. The findings could have important patient safety and public policy implications.
Patients in emergency departments across the United States often wait hours or days for a hospital bed to become available—a crisis known as boarding. A new study published in JAMA reveals significant variation in the timeframe for handoffs from emergency to inpatient care, even among patients accepted for hospital admission. Researchers from the Research in Emergency Systems and Quality Using EHRs Network (RESQUE-NET) analyzed data from 56 hospitals in 17 health systems and found that 23% of emergency department boarding patients waited at least four hours before receiving inpatient-quality care, such as medication management, therapy assessments, and discharge planning.
Many waited up to 24 hours before such care began. Co-first author Dr. Alex Janke, an emergency medicine physician at the University of Michigan Medical School, emphasized that these delays are distinct from the total boarding time, which is defined by the Joint Commission as more than four hours before an inpatient bed transfer.
The study suggests that hospitals, particularly those with larger patient volumes, higher Medicaid representation, and physician training programs, are more likely to experience prolonged delays in care transitions. Vulnerable patient groups, including those over 65, Medicare beneficiaries, and those with complex medical needs, are at greater risk for extended delays.
The authors recommend measuring these handoffs as a way to assess hospital capacity management. Starting in 2027, electronic health records will automatically report ED patient movements to federal databases, providing valuable data for transparency and potential payment adjustments for hospitals.
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