Prolonged ED Stays Increase Among Older Adults in the US

TOPLINE:

A US study showed that prolonged emergency department (ED) stays and boarding times among older US adults increased between 2017 and 2024, especially in academic hospitals.

METHODOLOGY:

• Researchers conducted a cross-sectional analysis using the Epic Cosmos electronic health records database, covering 1633 US hospitals and 78 million admissions from 2017 to 2024.
• The analysis focused on patients aged 65 years or older and assessed ED length of stay (LOS) of more than 8 hours and boarding time of more than 3 hours.
• Encounters were stratified by hospital type (academic, community, critical access, safety net, or other), and trends were assessed using linear regression.

TAKEAWAY:

• From 2017 to 2024, ED stays longer than 8 hours increased from 12% to 20%, while boarding delays rose from 22% to 36%.
• Academic hospitals saw the steepest increase in ED LOS from 19% in 2017 to 30% in 2024 and in boarding from 31% to 45% during the same period.
• Trend analyses revealed modest annual increases in ED LOS and boarding time from 2017 to 2020 (1.1% and 2.8%, respectively), followed by sharp rises during the COVID-19 pandemic from 2020 to 2022 (4.2% and 6.1%, respectively) and then partial declines between 2022 and 2024 (-1.7% and -3.2%, respectively).

IN PRACTICE:

“Worsening ED LOSs and boarding contribute to ED crowding, reflect systemic health care dysfunction, and, most importantly, harm individual patients,” the authors wrote. “Addressing these trends is critical to safeguarding both the health of older adults and the health systems caring for them,” they added.

SOURCE:

The study was led by Adrian D. Haimovich, MD, PhD, Beth Israel Deaconess Medical Center, Boston. It was published online on June 30, 2025, in JAMA Internal Medicine.

LIMITATIONS:

This study was limited by the overrepresentation of large academic hospitals, missing data for some encounters, reliance on system-generated time metrics, and the use of Centers for Medicare & Medicaid Services-defined thresholds that may not reflect individual hospital goals.

DISCLOSURES:

The study was funded by grants from Harvard Catalyst and the National Institute on Aging. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.