States implement measures to tackle emergency department boarding

Emergency department (ED) boarding has become a serious issue in the United States. Patients often wait on gurneys for hours or even days before getting an inpatient bed. This problem has been growing for 30 years and is now worse than ever. It not only makes patients uncomfortable but also leads to more medical errors and higher death rates. Moreover, it causes crowding in EDs, leading to longer wait times for everyone. Many factors contribute to this crisis. A shortage of nurses limits the number of beds that hospitals can staff. Additionally, there are fewer hospital beds available because of cost-cutting measures in recent years. Rising patient numbers, particularly among older and chronically ill individuals, have added to the strain. Unfortunately, hospitals have little incentive to change their practices, as remaining full is financially beneficial. However, some progress is being made. Recently, there have been efforts at both state and federal levels to tackle the ED boarding issue. For example, the Centers for Medicare and Medicaid Services (CMS) is working with Yale University to create a measure for tracking how long patients wait in EDs. If hospitals are graded on these standards, it could encourage them to improve. In Connecticut, all non-state-funded hospitals must now publicly report their ED boarding times. This transparency will likely put pressure on hospitals to make changes. The Leapfrog Group, a nonprofit that assesses hospital safety, is also adding ED boarding metrics to its evaluations. Maryland is taking action by linking hospital payments to ED boarding rates, which will come into effect in 2026. Hospitals with high boarding times may face financial penalties. While this is promising, it is uncertain whether the penalties will be enough to drive real change. Long-term solutions are necessary to fix the root causes of boarding. Hospitals need better staffing, improved workflows, and more efficient discharge processes. They should also collaborate with nursing and rehabilitation facilities to speed up patient turnover. Despite these efforts, the crisis may persist if hospitals do not receive adequate resources and support to implement these changes. States like Maryland and Connecticut are taking steps, but more action is needed across the country. Lawmakers and the public are increasingly calling for solutions to improve the situation in emergency departments.