Patients in hallways under fluorescent lights, new report details ER 'boarding' crisis in CT

Emergency department boarding – when patients are held, often in hallways, as they await an inpatient bed – is getting renewed scrutiny in Connecticut.

The attention comes following the release of a new report from the Connecticut Hospital Association, which found nearly 40% of patients in emergency departments across Connecticut were boarders.

“Meaning they needed to be admitted to the hospital, an order had been put in, but they remained in the emergency department,” said Dr. Chris Moore, an emergency medicine physician at Yale New Haven Hospital, who was an author of the report.

Boarding is a public health problem, Moore said, presenting challenges for both patients and medical workers. Boarders place constraints on space and on personnel to care for an incoming patient. They can also drive staff burnout and violence against health care workers.

Boarding numbers varied widely from hospital to hospital – from 9% at UConn John Dempsey Hospital and St. Vincent’s Medical Center, to 62% at Saint Francis Hospital and 63% at Hartford Hospital, the report showed.

Urban hospitals typically faced higher boarding numbers than rural ones.

In some cases, patients waited for up to seven hours or longer to get admitted to the emergency department. Moore cited data showing those patients then waited for at least four more hours to be admitted to the floors, often lying on hard stretchers in hallways under fluorescent lights.

“That's just the minimum,” he said. “Many of these people are waiting much longer and they're sick, they're not getting the care that they would get on an inpatient bed.”

Hartford Hospital said in a statement that it understands “the issue of overcrowding in emergency departments” and remains committed to identifying solutions, including a significant hospital expansion.

“We are also continually advancing on-demand health care across the state,” the statement continued, citing the opening of dozens of urgent care centers in the state along with virtual health stations and on-site clinics. “All of these offer improved access for patients who need non-life-threatening medical care."

A spokesperson for Saint Francis Hospital declined to comment.

Overcrowding due to overuse? Not so fast, report says 

While Moore said it is critical to expand health care capacity, overutilization of emergency departments is not the reason they’re overcrowded, he said.

Rather, he said patients admitted to the hospital but continuing to remain in the emergency department are the root cause.

A state working committee made up of emergency department physicians began convening in 2023 to advise the commissioner of the Department of Public Health on emergency department boarding and crowding.

In its final December 2024 report, members responded to what the state’s Office of Health Strategy claimed were avoidable emergency department visits, meaning, if those patients had gone elsewhere, hospitals would not be so crowded.

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The committee disagreed. A patient might go to the emergency department for chest pain and after an evaluation, the physician might determine that it was non life-threatening.

But patients are not expected to know if something like chest pain is a heart attack or something less serious, the working committee said, adding that “it is the unserious conditions that are easiest to deal with.”

“Uncomplicated upper respiratory infections, sprained ankles, and sore throats may be able to be cared for elsewhere,” the committee wrote, “but they are not what is causing ED crowding as they can be quickly discharged.”

‘The solution is data’

Moore and other emergency department physicians advocated for legislation requiring hospitals to send boarding data to the state. In 2024, “An Act Concerning Emergency Department Crowding” was signed into law.

The law requires hospitals to provide data on the number of patients at every hospital in Connecticut who received treatment in the emergency department, the number of patients who were then admitted to the hospital and for how long the admitted patients waited to get a bed in the hospital.

Hospitals are required to analyze the data annually starting 2025, and are also required to report their findings and recommendations to the state’s Public Health Committee, including policies and procedures to reduce wait times, improve hospital admission and identify root causes for admission delays.

Moore’s working group on the boarding problem heard from emergency department physicians across the country, whose statements were included in a report by the working group to lawmakers last December.

Dr. Todd Taylor, with the Arizona College of Emergency Physicians, told lawmakers he has been working on the issue of overcrowding for decades.

“I had one of my patients die in the hallway and went on a crusade,” Taylor told the working group last year.

“This is literally life and death,” Taylor said. “I believe the solution is data – you can’t manage what you can’t measure.”