When Elisabeth Rosenthal’s husband, Andrej, went to a New York City emergency room in the summer of 2024, the family thought they were in for a quick in-and-out visit. Instead, what was supposed to be a brief trip stretched into more than 36 hours of waiting while he lay on a hard stretcher, stuck in the ER until a real inpatient bed opened up. That limbo is not a one-off horror story; clinicians and federal researchers now say it is a recurring feature of emergency care, where the ER often functions as a crowded holding pen instead of a fast track to a hospital room.
Rosenthal recounts the ordeal in a KFF Health News dispatch that was republished by the Miami Herald, using her family’s experience to frame a wider crisis. In that reporting, Boston emergency physician Adrian Haimovich labels long-term "boarding" in the emergency department as "barbaric" and notes that some patients spend days on gurneys while they wait for an actual room, according to the Miami Herald.
Why Officials Call Boarding A Crisis
Federal officials are not brushing this off as bad luck. In 2024, the Agency for Healthcare Research and Quality convened a summit and later declared in a technical report that emergency-department boarding is "a public health crisis" tied to higher mortality, more medical errors, longer hospital stays and deeply unhappy patients. The report traces the roots of the problem to mismatches between capacity and demand, payment incentives that reward full schedules and delays in safely discharging patients, all of which turn an overcrowded ER into a serious patient-safety risk, according to AHRQ.
New Federal Reporting: What Will Change
Policy is starting to inch toward those realities. In November 2025, the Centers for Medicare & Medicaid Services finalized a CY-2026 outpatient rule that creates a new Emergency Care Access & Timeliness electronic clinical quality measure and requires hospitals to track boarding data. Hospitals will begin reporting voluntarily in 2027, and reporting becomes mandatory in 2028. The idea is to finally build consistent, national metrics for a problem that has mostly lived in the shadows, according to CMS.
Band-Aid Fixes And Financial Incentives
Hospitals have been scrambling with what are, in many cases, Band-Aid fixes. They roll out bed-tracking dashboards, set up discharge lounges and juggle elective admissions into already packed schedules. Those moves can make the waiting room look better without actually creating more staffed inpatient beds. The result in many facilities is an improvised overflow ward or repurposed floor that does not have the nursing staff of a true inpatient unit, an arrangement Rosenthal describes in her reporting for the Miami Herald.
Older adults pay a particularly steep price for these workarounds. A national analysis led by Dr. Adrian Haimovich shows that prolonged emergency-department stays in older patients are associated with delirium and higher in-hospital mortality. His research also documents a sharp rise since the pandemic in boarding episodes lasting more than 24 hours among people 65 and older, findings published in JAMA Internal Medicine.
Measurement Will Not Magically Free Beds
Emergency medicine organizations have largely applauded the new CMS measure as a necessary way to shine light on boarding, while warning that counting the problem will not, by itself, produce a single new staffed bed. The American College of Emergency Physicians called the OPPS change an important first step and argued that public reporting has to be backed up by changes in operations and payment policy, according to ACEP.
In its summit report, AHRQ lays out a menu of realistic near-term moves: smoothing surgical schedules to avoid huge weekday admission spikes, pushing to discharge patients earlier in the day, appointing dedicated bed managers and building regional systems to track bed availability. All of that, the report notes, still depends on hospital executives and policymakers being willing to change how they pay for and staff care. Those are the levers federal experts say will be needed if hospital data are going to translate into fewer people parked on stretchers and more patients moved into properly staffed rooms, according to AHRQ.
For patients and families walking into big-city ERs, the federal reporting timeline creates a short window to see if transparency actually nudges local systems to act. Voluntary reporting begins in 2027, with mandatory reporting in 2028. Until hospital and health system leaders reassign staff, reset surgical schedules and invest in post-acute capacity, the human cost of boarding will still be measured in exhausted patients on hallway stretchers, anxious relatives trying to sleep upright and clinicians stretched past their limits, making the case for reform far more vividly than any dashboard ever could.
