Boarding, Crowding, and Wait Times

With nearly 150 million visits annually, it is undeniable that emergency departments are crowded. Stubborn misperceptions persist about the reasons why it may take time for some patients to be treated.

There are two kinds of waiting: in the waiting room and for a hospital inpatient bed.

You may be in the emergency department for hours, especially if your health problem is complicated. Determining why you are sick may require many tests. The doctor may need to talk with another specialist to find out how to help you feel better. It also may take several hours for doctors to stabilize you so that your condition is not life-threatening.

The good news is that wait times are improving. In 2019, the Centers for Disease Control and Prevention (CDC) said that more than one-third (39 percent) of patients wait less than 15 minutes to see a physician, physician assistant or nurse practitioner. Nearly three-quarters (72 percent) of patients are seen in less than one hour.

The concept of triage, treating the most serious injuries first, is one factor. It is important to note that crowding is not due to an influx of nonurgent patients. CDC states that about 95 percent of visits are medical emergencies. The wait gets longer because physicians and patients rely on the emergency department from within the hospital.

Many hospitals are challenged to move already admitted patients to other inpatient beds within the hospital in a timely manner. Emergency care teams are often left responsible for maintaining the health of patients already admitted to the hospital, whether they need to be stabilized between medical procedures or need a place to wait safely while the other specialists locate the most appropriate care providers.

While a hospital takes time to locate appropriate care or between transfers, the patient will often wait. This is considered “boarding.” When prolonged boarding reduces the number of beds available for new patients, it becomes a challenge for everyone, especially in communities with smaller facilities or limited options for specialized care.

Many hospitals have stopped “boarding” patients in emergency departments and instead, once they are admitted to the hospital, move them directly to the floors to which they are admitted. This spreads the burden of overcrowding throughout the hospital and often results in beds becoming more quickly available. That’s one reason why ACEP continues to advocate for more resources to improve mental health care access from the ER. 

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Access to Care Boarding/Crowding ER101 Public Education