Multicenter Study Quantifies Delays in Care for Emergency Department Boarders

Emergency department (ED) boarding—the practice of keeping admitted patients in the ED while awaiting an inpatient bed—creates hazardous delays in definitive care. Prolonged transitions expose older and medically complex patients to medication errors, missed assessments, and discharge planning setbacks. Hospitals struggle to maintain patient flow while ensuring timely handoffs to inpatient teams. A new multicenter study now quantifies how long ED boarders wait for inpatient management and highlights wide variation across U.S. hospitals.

Researchers from the University of Michigan and the nationwide Research in Emergency Systems and Quality Using EHRs Network (RESQUE-NET) reported findings published in JAMA on August 17, 2026. The RESQUE-NET team pooled data from 56 hospitals across 17 health systems to measure the time between the end of emergency care and the start of inpatient management for patients boarding in the emergency department (ED). Participating institutions included Beth Israel Deaconess Medical Center and the University of Pennsylvania.

The study defines inpatient management as the assumption of care by hospital teams responsible for medication management, therapy assessments, and discharge planning, even when patients remain physically in the ED. Investigators used a four-hour benchmark to assess timeliness, reflecting a Joint Commission standard that identifies boarding beyond four hours prior to bed transfer as a critical safety issue. The handoff interval was distinguished from total boarding time, which can extend much longer.

Across participating hospitals, 23% of ED boarders waited at least four hours before inpatient teams assumed care. Many patients experienced 12- to 24-hour delays. Prolonged waits were more common at larger hospitals, facilities caring for more Medicaid patients, and teaching sites. Patients over 65 years, those covered by Medicare, and those with higher illness acuity were also more likely to face extended delays. The authors note the analysis is not nationally representative and call for further research.

The findings suggest that tracking ED-to-inpatient handoff times could help assess how hospitals manage inpatient capacity constraints. At U‑M Health’s University Hospital, hospitalist, general internal medicine, and family medicine teams assume care for boarders in the ED, supported by the Michigan Medicine Command Center (M2C2) to optimize bed use.

Beginning in January 2027, hospitals’ electronic health record systems will start sending anonymous ED throughput data to a federal reporting system, with reporting required for all hospitals a year later. Boarding times will be publicly available on the Care Compare site, and by 2030 certain ED measures will influence Medicare payment rates. A bill in Congress seeks additional transparency around bed availability and ED data tracking.

“Hospital boarding in emergency departments is endemic across the U.S. right now. Health systems must have a plan for resourcing clinical teams to keep patients safe while they board. This is especially important for older patients, those with multiple chronic conditions and those taking high-risk medications,” said Alex Janke, M.D., M.Sc., M.H.S., assistant professor of emergency medicine at the University of Michigan Medical School and member of the U‑M Institute for Healthcare Policy and Innovation.

“Risk concentrates at these moments where one clinical team hands a patient to another. Emergency and inpatient teams work on different clocks, and they're doing this under resource constraints. What our data show is that some hospitals consistently manage that transition in under four hours, and others take more than a day, which suggests it comes down to how a hospital organizes the work, not just how full it is. Where this goes well, the work has been assigned, with emergency and inpatient teams given the resources to manage these patients wherever they happen to be,” Janke said.

Related Links
University of Michigan Medical School