U.S. emergency rooms overflow as patients face long delays
WASHINGTON, UNITED STATES — Emergency departments across the United States are holding admitted patients on hallway stretchers for hours, days and sometimes weeks, a practice federal health officials have labeled a public health crisis straining hospital operations nationwide and forcing providers to deliver care in spaces never designed for inpatient stays.
The practice, known as ED boarding, occurs when patients who require admission wait in the emergency department because no inpatient bed is available upstairs.
According to a report from The Atlantic, the Department of Health and Human Services’ Agency for Healthcare Research and Quality concluded that “Emergency department (ED) boarding is a public health crisis in the United States,” warning it contributes to higher mortality rates, medical errors and longer hospital stays.
The Joint Commission, which certifies U.S. hospitals, echoed that assessment, calling boarding a “serious public health crisis” and among the most complex challenges facing health systems today.
Boarding strains hospital operations and frontline staff
The crisis is reshaping how emergency departments function, with some facilities now holding more boarded patients than those being actively evaluated.
“Everyone knows about this problem, and no one cares enough to do anything about it,” said Adrian Haimovich, an emergency physician at Beth Israel Deaconess Medical Center who studies the issue.
Boarding rates for patients aged 65 and older have risen sharply since the pandemic, according to Haimovich’s research.
For hospitals, the ripple effects include overworked nursing staff, ambulance diversions and mounting pressure on emergency medicine teams expected to care for boarders while simultaneously evaluating new arrivals.
Providers seek relief as financial pressures mount
Gabe Kelen, director of emergency medicine at Johns Hopkins University, argued the issue is structural rather than operational.
“The problem isn’t inefficiency—it’s the way health-care finance is structured,” Kelen told The Atlantic, noting that hospitals prioritize elective admissions tied to higher-margin procedures such as joint replacements and cardiac catheterizations.
Chris DeRienzo, chief physician executive at the American Hospital Association, said in an email that “Long ED wait times and boarding have root causes that extend far beyond EDs,” pointing to the high cost of opening beds and a nationwide shortage of rehabilitation facilities.
As providers search for relief, many health systems are rethinking workflows and offloading non-clinical functions — from intake documentation and medical billing to scheduling, prior authorization and discharge coordination — to outsourcing partners, freeing clinicians to focus on bedside care while administrative bottlenecks that delay bed turnover are resolved behind the scenes.
