Research highlights significant delays in the transition from emergency care to inpatient management for admitted patients.
RT’s Three Key Takeaways:
- Transition Delays: A study published in the Journal of the American Medical Association (JAMA) found that 23% of patients wait at least four hours for the transition from emergency care to inpatient management while boarding in the emergency department.
- Patient Risk: Delays in handoffs are most common among patients over age 65 and those with high illness acuity, potentially postponing essential therapy assessments and medication adjustments.
- Transparency Mandates: Federal reporting of emergency department (ED) boarding data will become mandatory for all hospitals by 2028 to address patient safety concerns and inpatient capacity.
A new study has identified wide variation in how long admitted patients wait for inpatient-quality care while boarding in emergency departments, with many facing delays of 12 to 24 hours before a formal handoff occurs, according to new research in JAMA.
The research, conducted by the Research in Emergency Systems and Quality Using Electronic Health Records Network (RESQUE-NET), analyzed data from 56 hospitals across 17 healthcare systems. The findings indicate that 23% of patients accepted for general hospital care wait at least four hours for the transition from emergency care to inpatient management.
This transition is critical because inpatient care involves different clinical goals, such as medication adjustments, therapy assessments, and discharge planning. According to the Joint Commission, boarding for more than four hours is a significant patient safety risk.
“Emergency departments don’t control who arrives or when. Ambulances keep coming and waiting rooms fill. Emergency care is organized around that reality: rapid assessment, stabilization of life- and limb-threatening illness and injury, and the first hours of treatment, with attention always available to new patients as they come in the door,” said Alex Janke, assistant professor of emergency medicine at the University of Michigan Medical School. “Inpatient care runs on a different clock, orchestrating clinical resources, pursuing diagnoses, adjusting medications, and discharge planning over days. Great care requires both, and delays in the transition from emergency care to inpatient management can be dangerous.”
Factors Influencing Boarding Times
The study found that prolonged delays were more frequent at larger hospitals, teaching facilities, and institutions serving higher volumes of Medicaid patients. Furthermore, patients over 65, those covered by Medicare, and individuals with higher illness acuity were more likely to experience extended waits before an admitting team assumed responsibility for their care.
For complex patients, these delays can impact the timing of assessments by physical and occupational therapists, which are essential for determining appropriate discharge settings.
“Hospital boarding in emergency departments is endemic across the US right now. Healthcare systems must have a plan for resourcing clinical teams to keep patients safe while they board,” said Janke, who served as the study’s co-first author, in a news release. “This is especially important for older patients, those with multiple chronic conditions, and those taking high-risk medications.”
Regulatory Changes and Transparency
To address the boarding crisis, the federal government is implementing new reporting requirements. Starting in January 2027, electronic health record (EHR) systems will begin feeding anonymous data regarding ED patient flow to federal reporting systems.
This reporting will be mandatory for all hospitals by 2028. The data, including boarding times, will be published on the Care Compare website. By 2030, hospital performance on specific ED measures will influence reimbursement rates from the Medicare program.
Current strategies to mitigate risk include mobilizing inpatient teams, such as hospitalists, to assume care while patients are still physically located in the ED.
“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,” said Janke in a news release. “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.”
