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Stop The Wait at the ER (Now the Emergency Department (ED))
The Issues of Emergency Medicine - Boarding
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Have you or a loved one experienced the overcrowded chaotic world of a Hospital Emergency Department (ED)?
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An ED is supposed to be where acutely ill or those suffering from life threatening conditions go. It is also where those who cannot see their doctors go for routine care.
Lack of basic appointments, coupled with the use of EDs for primary care for those on Medicaid (who sometimes call 9-1-1 to chauffeur them to a doctor), coupled with excessive illegal immigration who use EDs as their Primary Care Physician has led to an overcrowded, overwhelmed ED especially in poorer communities and especially in the winter.
When it has been determined that you or a loved one is sick enough to be hospitalized what should happen is that you are admitted and taken to your hospital room.
Unfortunately, that is not often the case. Instead, you are left in the ED, not receiving the care as a seriously ill person requires while they wait for a hospital bed. This waiting in the emergency department for a bed is called BOARDING.
In a recent article in Medscape Medical News (dated November 11, 2025) entitled “When The Waiting Never Ends. How Emergency Department Boarding Hits Hospitalists And How To Solve It” sheds light on this problem. Most of you have probably never heard of the term boarding, but this is what happens and what it is called in EDs throughout the country.
In January of 2022, 40% of the patients that were admitted to the hospital in the ED had to wait more than four hours in the ED before they could have a hospital bed, and 6% stayed longer than 24 hours. These are the sick patients that need emergency hospitalization, and the longer they sit in the ED before they are admitted to the hospital for proper care the sicker they get.
Also, by being in a general population as a susceptible patient, these Boarders are also exposed to the plethora of contagious infectious diseases of all the coughing and breathing ED patients sitting in the waiting rooms while they wait.
The Northeast Conundrum – Increased Boarding in Winter Months
Boarding is exacerbated in the Northeast during the winter time where up to 8% of the patients spend 24 hours in the ED waiting for a bed. Imagine a seriously ill patient spending 24 hours in the ED, not receiving the level of care they need and probably not being fed on a regular basis. Also, imagine the strain on the family member who is waiting there.
The article went on to conclude that long boarding times and holding in the ED results in higher mortality, longer lengths of stay, and greater readmission risks. Certainly none of these results in Making America Healthier Again.
WHAT IS THE SOLUTION? – Proactive Care and Avoidance of the ED
If you have an acute illness that is not life threatening, the best place for you to be seen is by you own doctor. Unfortunately, our healthcare system has consolidated into an institution and a hospital-based healthcare system that no longer accommodates these urgent visits. Take a look at every physician practice, there is a big Hospital emblem or logo or affiliation.
To make an appointment, you either go online or call a call center where a non-medical scheduler fits you into available slots in a doctor’s schedule based on availability. If there is no availability then you cannot be seen.
What about the Urgent Care Centers? Can they alleviate the Strain on the ED?
If you cannot see your Primary Care Physician, your next option is the Urgent Care Center (most are owned and operated by the hospitals). These facilities can handle common illnesses, but if you need specialty care or have an uncommon illness they are not the right fit. They are good for your basic workup and despite often being Board Certified, they are reduced to an elevated LPN.
Once you have experienced an Urgent Care Center, most (except hypochondriacs) get frustrated by the lack of immediate solutions to their illnesses that they do not come back.
So If Urgent Care isn’t an option – Where do you Go? – Take a Seat in the ED
If you cannot see your physician and Urgent Care is out of the question, you are back at the ED. If your symptoms do not warrant a triage approach, take a number, fill out a form and take a seat. Also expect to pick up a new disease you didn’t have before in the cesspool of contractible illnesses. Maybe you will pick up some new rare and foreign infection. So now the ED is a double edged sword.
If you’re really sick then you could be waiting a long time for a bed while you get sicker.
So How do we solve this? We cannot treat your life like a seat on an airplane.
Airlines tend to oversell seats as they know there are cancellations. Thus they overbook – THIS SHOULD NOT BE THE BUSINESS MODEL FOR MEDICINE
Institutions that provide outpatient care MUST leave slots open in their schedules to fit in urgent patients.
The Real Solution:
WE MUST RESTORE PRIVATE PRACTICES WITHOUT THE HOSPITAL RUN POLICIES AND PROCEDURES SO THAT THEY CAN REVERT BACK TO ACCOMODATING SICK PATIENTS WITH THESE “EMERGENCIES” SO THEY NO LONGER FLOOD THE ED.
Other Boarding Issues – Hospital After Care
Coordination of care between the ED and the Hospital to determine how hospitalized patients awaiting discharge can be discharged more efficiently and when necessary be transferred to other facilities must be resolved, especially where the patient needs a discharge to a rehab or nursing home type facility. The inability to find a bed after discharge causes boarding issues on the front end.
Teamwork and identifying problems is the first step to a solution.
In the past I served on the Operating Room Committee of my hospital. Our concern was that operating rooms were running late, causing problems for patients, doctors and creating staffing issues.
Our Committee included, Surgeons, Anesthesia, O.R. Nursing Supervisors, Admitting Supervisors and Nursing Supervisors and other Hospital Administrators. We would get reports every month on the number and percentage of cases that were delayed and why they were delayed. The result of this collaboration was a reduction in delays and a more efficiently running operating room.
The same collaborative team effort, which has been done in some hospitals needs to be expanded. Hospitals should have to report their boarding times and when they are too high hospital reimbursements should be reduced. Also, it can potentially result in shifting Ambulance routes to alternate hospitals and EDs (especially in larger cities).
Finance Drives Healthcare
By incentivizing/penalizing Hospitals, it will create the financial incentive to force hospitals to admit sick patients faster, shorten hospital stays, reduce unnecessary deaths and free up overwhelmed EDs to take care of their sick patients.
By Addressing these issues – We actually can Make America Healthier Again
 | A guest post by
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