There’s a growing emergency in the emergency room, study warns

More patients are waiting hours for treatment

By Mark Huffman of ConsumerAffairs

August 7, 2025

• One in four ER patients waits over four hours for a hospital bed, even during non-peak months.

• Nearly 5% of admitted patients wait 24+ hours in emergency departments during winter.

• Boarding times have remained dangerously high for four years, threatening care quality and emergency readiness.

Hospitals across the United States are facing a persistent and worsening crisis: patients sick enough to require inpatient care are being forced to wait sometimes for hours, sometimes for an entire day in emergency departments due to a lack of available hospital beds.

This practice, known as boarding, has surged in recent years, according to a new study published in Health Affairs by researchers from the University of Michigan Medical School and Beth Israel Deaconess Medical Center.

The study analyzed more than 46 million emergency visits across 1,500 hospitals in all 50 states from 2017 through September 2024.

From hours to days: A dangerous trend

While boarding was already increasing before the COVID-19 pandemic, the problem accelerated in mid-2020 and has remained at dangerously high levels ever since across all seasons, the researchers reported.

Key findings include:

• From 2022 to 2024, more than 25% of admitted ER patients during non-peak months waited four hours or more for a bed.

• During the winter months, that figure rose to 35%.

• By 2024, nearly 5% of ER-to-inpatient admissions in peak months faced boarding times of 24 hours or more, a level virtually unheard of before the pandemic.

These boarding times far exceed national hospital safety guidelines, which recommend no more than four hours of waiting in the ER before transfer to an inpatient bed.

Whos most affected?

The study reveals that boarding affects all regions and demographics, but certain groups bear a disproportionate burden:

• The Northeast showed the highest rate of 24-hour boarding.

• Increases were especially sharp for:

  • Adults aged 65 and older

  • Patients whose primary language is not English or Spanish

  • And Black patients.

The researchers said these disparities suggest broader systemic issues in healthcare equity and resource allocation.

The root causes are both structural and administrative, according to both the studys authors and a recent summit convened by the Agency for Healthcare Research and Quality (AHRQ):

• Mismatch between the number of emergency visits and the capacity of inpatient care.

• Inefficient discharge processes that slow the turnover of inpatient beds.

• Backlogs in mental and behavioral health services often require prolonged ED stays.

This growth in long boarding times for admitted patients is the most important driver of crowded conditions and long wait times in emergency departments, said lead author Dr. Alex Janke, emergency physician at U-M Health. Sustained high levels of boarding suggest the health system is at risk of collapse in the event of another pandemic.

The study concludes things got worse during the pandemic. Even in 2024s lowest-boarding months, four-hour-plus waits were more frequent than the worst winter months of 2017 to 2019.

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