05/07/2026
Elisabeth Rosenthal learned the hard way that if you need admission to a hospital, you might remain in the emergency department for hours, even days, while waiting for a real hospital bed.
As he battled esophageal cancer, her husband, suddenly needed to go to the hospital in 2024. After 36 hours in the emergency department, he finally got a bed “upstairs”—which turned out to be another temporary area for ED overflow lacking adequate personnel. “The overworked staff did the best they could, but that was far from good care,” Rosenthal writes.
When she started asking around, Rosenthal quickly discovered that ED boarding has become commonplace in the past five or so years and is getting worse, more or less omnipresent in hospitals.
Today, hospitals run like airlines and intentionally overbook, Gabe Kelen, the director of emergency medicine at Johns Hopkins University, said. “An empty, staffed bed is a money loser, so the institution has an incentive to keep beds full and make new patients wait,” Rosenthal writes.
For ED boarders, “the rules governing acceptable care and safety measures become much less clear,” Rosenthal writes. Despite a national push to establish “safe staffing” nurse-to-patient ratios in EDs, if a boarder has a medical complaint that needs quick attention, it’s easy for them to fall through the cracks, Adrian Haimovich, an ED doctor, told Rosenthal.
“The problem isn’t inefficiency—it’s the way health-care finance is structured,” Kelen told Rosenthal.
🎨: Isabel Seliger / Sepia
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