How to Reduce ED Boarding and Improve Bed Capacity in Hospitals
Key takeaways:
- The causes of ED boarding lie outside the emergency department, with inpatient units.
- Therefore, ED-based interventions have limited success in alleviating ED boarding.
- The most effective solutions will address discharge timing (such as moving discharges to earlier in the day), and eliminate practices such as batching.
- Rapid Room Turnover addresses these issues, by clearing away manual obstacles (such as documenting discharges and sending alerts to environmental services), streamlining workflows and ensuring higher room availability.
ED boarding, by the numbers
Over the past several decades, emergency department boarding has increased dramatically.
In one study of 46.2 million hospitalizations across 1,500 hospitals, researchers found that from 2017-2024, 25% of all admitted patients waited four or more hours for a bed; during winter months, this number was approximately 35%. The same team found that even the lowest rates of boarding patients in 2024 were higher than the peak boarding rates of patients in 2017 through 2019.
When it does occur, ED boarding is also growing in length. Another review of EHR data from 56 EDs across 17 health systems from June 2024 to May 2025 found that of the 492,000 admitted patients, nearly 53.6% boarded in an ED bed for at least four hours. Handoff delays ran to almost a full day in length, and up to 17% of admitted patients went at least four hours without being seen by an inpatient team; in the most extreme cases, patients waited 24 hours or longer.
As one may expect, this increase in ED boarding frequency and length also conflicts with established standards of care. According to The Joint Commission recommendations, ED boarding should not exceed four hours for health and safety reasons. Prolonged boarding times are associated with severe consequences including mortality, morbidity, treatment delays, and more.
ED boarding is an inpatient problem, not an ED problem
Multiple studies have determined that the lack of bed availability in inpatient units is the primary contributor to ED boarding. One pivotal 2003 report in The Annals of Emergency Medicine modeled an ED patient flow diagram, with inputs, throughputs, and outputs.
- Inputs included unscheduled visits from walk-in patient, transfers, and ambulance volume.
- Throughputs included diagnostic testing and ED treatment, with a major focus on patient length of stay.
- Outputs include a wide array of potential patient dispositions, such as leaving without being seen (LWBS), transfer to ambulatory care, inpatient admission, and more.
Outputs are the most crucial. While ED boarding is exacerbated by factors such as staffing, the primary bottleneck to moving admitted patients out of the ED and into an inpatient unit is a lack of available, staffed inpatient beds. This can result from high census on those units and from delays in cleaning and turning over rooms.
Because the root cause of ED boarding occurs downstream from the ED, any ED-based interventions have little effect on the numbers; one report found that expanding ED capacity simply enabled more patients to be boarded and further strained already overburdened staff. Without addressing outputs, or the flow of admitted patients from the ED into inpatient beds, hospitals cannot alleviate ED boarding.
The root causes: batching and discharge delays
Two patterns in inpatient discharge workflows have a direct impact on hospitals’ ability to meet the ED’s demand for clean beds.
Batching. When clinicians complete discharge documentation in batches, rather than in real time as discharges happen, the effects ripple downstream. Most hospitals require EVS to clean a room within 15 minutes of a documented discharge, but if several discharges are logged at once, EVS can typically keep pace with only one or two.
Discharge lag. A related problem is the lag between when a patient physically leaves the hospital and when that discharge is actually documented. This gap averages around 90 minutes, largely because bedside nurses, who are responsible for logging the discharge, are busy attending to other patients and can’t always document in real time.
This lag matters because it delays everything downstream: EVS can’t be dispatched to clean a room, and the bed can’t be marked available for the ED, until the discharge is documented, even though the bed has physically been empty the whole time.
At the root of both problems, batching and discharge lag, is the same structural issue: clinicians are asked to fit administrative documentation in between direct patient care. They’ll always get to it eventually, but it will rarely be their top priority (and appropriately so). As long as discharge status depends on a busy clinician logging it in real time, batching and lag will persist. The real fix is to automate these steps and take the documentation burden off clinicians, so bed status reflects reality without waiting on staff who have more pressing priorities.
How Rapid Room Turnover smooths discharges and solves issues
Kontakt.io’s Rapid Room Turnover was designed to facilitate smoothing and reduce batching while lightening the workloads on care teams. Rapid Room Turnover uses RTLS to detect when a discharged patient physically leaves the hospital and then sends an AO3 message which marks the discharge as complete and the room as soiled in real time.By enabling hospitals to know exactly when a bed is empty so they can begin the bed turnover process immediately, Rapid Room Turnover speeds up room availability, and allows admitted patients to move into those beds hours sooner.
On average, 90 minutes elapse between a patient physically leaving and their discharge being documented…a 200-bed hospital using Rapid Room Turnover can recover up to $2.6 million in annual operating cost reductions and roughly 400 additional ED visits captured each year.
In essence, Rapid Room Turnover automates many of the clinician documentation steps that slow inpatient discharges and contribute to ED boarding. On average, this automation saves 90 minutes per discharge, which means 90 minutes less of ED boarding for the next patient.
To learn more about Rapid Room Turnover, contact us today.