Patients admitted through the ER are getting measurably sicker while they board in ERs waiting for a hospital bed, according to a new study published in Annals of Emergency Medicine that delivers a stark warning about one of the most persistent failures in American hospitals.

These findings should alarm hospital leaders, policymakers and frankly anyone who may someday need emergency care.

Here’s the issue. Across America, thousands of patients every day are told they need to be admitted, but no inpatient bed is available. So they wait. Sometimes for hours; sometimes much longer. Patients wait on stretchers in hallways, behind curtains, in noisy, crowded spaces designed for short-term evaluation, not ongoing hospital care.

The dysfunction of ER boarding has become a normal part of U.S. hospital operations.

The study, led by researchers at Johns Hopkins University, is the largest analysis to date of clinical deterioration among boarded patients. Using more than six years of data from 2018 to 2024 across a five-hospital academic health system, the authors examined 173,168 patients admitted to general medicine beds.

Their question was simple: how often do patients worsen while boarding in the ED, and does longer boarding time matter? The answer: a resounding yes.

Among the patients studied, about 3.6%, experienced early clinical deterioration, defined as escalation from a standard inpatient bed to an intermediate care unit or ICU within 48 hours of the admission order.

Deterioration means that a patient’s illness worsened, and significantly so. For example, it can mean vasopressors were used for dangerously low blood pressure, a breathing tube was placed for mechanical ventilation or a patient needed much more intensive monitoring and treatment.

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