If Hotels and Restaurants Can Do It, So Can Hospitals. Right?

John Milton said, “They also serve who only stand and wait.” The 17^th century English poet was never a patient in a hospital emergency room.

A new study is out that found wide variations in how long patients wait in the ER before the hospital can admit them up to a bed on an inpatient unit. It’s just another type of unexplained variation in healthcare that limits access, increases costs and threatens quality. Not to mention that it drives patients and their family members nuts.

It’s one thing to wait for your hotel room after check-in time because the room isn’t ready yet. Or wait for your table after your reservation because the restaurant hasn’t cleared the table yet. It’s another to wait for hours on a gurney in a noisy hall when you’re acutely sick or injured because an inpatient bed isn’t ready for you yet.

Researchers looked at patient boarding times at 56 ERs at hospitals operated by 17 health systems and published their results in a short research letter in the Journal of the American Medical Association. The health systems, which the study identified in its supplemental materials, included such prominent names as Beth Israel Deaconess Medical Center, Cedars Sinai, Rush University Medical Center and Mayo Clinic.

The study pool consisted of about 3.3 million ER visits by adults 18 or older from June 1, 2024, through May 31, 2025. Of those visits, the hospitals admitted nearly 500,000, or about 15%, of those patients. Of those admitted patients, 23% had to wait at least four hours for an inpatient bed.

Here’s the unexplained variation part. Of those 23%:

• 17.3% had to wait at least four hours.
• 4.7% had to wait at least 12 hours.
• And 0.9% had to wait at least 24 hours.

The researchers correlated longer boarding times with academic medical centers, hospitals with more beds and hospitals that treated more Medicaid patients.

“This analysis detected meaningful hospital-level variation in the timeliness of transition from ED to inpatient management, a latent safety risk not captured by current quality measures,” the study said. “Despite the critical role of inpatient teams in addressing boarding, initiation of inpatient management often lagged far beyond the admission decision.”

The researchers called for a new patient safety measure that would financially incentivize hospitals to reduce patient boarding times.

As we say at 4sight Health, we get the healthcare we pay for. If we want to build better healthcare, that sounds pretty reasonable to me. Let’s stop paying hospitals for boarding patients in the ER. You can bet that the problem will go away pretty quickly.

If the best hotels and restaurants can figure it out, I’m sure the best health systems can do it, too.