I am writing this from a hospital bed, though it took far longer than it should have to get here.
I was directly admitted by a surgical team for treatment of a post-surgical infection. The expectation in such cases is straightforward: admission to an inpatient unit for monitoring, treatment, and recovery. Instead, I spent hours in a secondary waiting room, followed by placement in a chair in a shared emergency department (ED) space. I was told I might remain there for at least 24 hours before transfer to an inpatient room.
Only after raising concerns, and with the help of an attentive clinician, was I moved to a quieter space with a bed. Even then, that space remained in the ED and the area remained shared, with continuous noise, frequent interruptions, and little opportunity for rest.
This experience is not unique. It reflects a widespread and deeply embedded practice in modern health care: ED boarding.
Emergency departments are, by design, high-intensity environments. They are built for rapid assessment and stabilization, not for prolonged care. Yet across the country, they are increasingly used as holding areas for patients who have already been admitted to the hospital but are waiting for an inpatient bed.
This practice, known as ED boarding, is often framed as a throughput or capacity issue. But from a patient’s perspective, it is something more fundamental: a breakdown in the basic conditions required for safe and humane care.
Shared ED spaces compromise privacy and dignity. They expose patients to excessive noise, continuous disruptions, and, in some cases, behavior from others that is distressing or inappropriate. For patients recovering from surgery or managing infections, these environments also raise legitimate concerns about infection control.
The risks are not merely theoretical. Transitional care environments, where patients are moved, handed off, and managed outside standard workflows, are well documented as high-risk for communication failures and clinical errors. Staffing in EDs is often stretched, and continuity of care can suffer as responsibility shifts between teams. In short, the environment is poorly aligned with the needs of patients who have already crossed the threshold from emergency evaluation to inpatient treatment.
In my case, conditions improved only after persistent self-advocacy and intervention by my surgeon. I knew what to ask for. I knew how to escalate concerns. I was comfortable navigating the system.
That should not be the determining factor in whether a patient receives a bed.
Patients without medical literacy, confidence, language fluency, or familiarity with health care systems are far less likely to advocate effectively for themselves. When basic standards (privacy, rest, appropriate placement) depend on a patient’s ability to push for them, the system is not just inefficient; it is inequitable.
Hospitals rightly emphasize their commitments to patient-centered care, safety, and dignity. Accrediting and regulatory bodies reinforce these expectations, emphasizing the importance of appropriate environments, continuity of care, and respect for patient privacy. ED boarding challenges all of these principles.
A direct admission, particularly for a condition requiring monitoring, such as a post-surgical infection, should result in timely placement in an inpatient setting. Prolonged stays in ED chairs or shared spaces fall short of what most would consider an acceptable standard of care.
To be clear, this is not a critique of individual clinicians. The care I received from my surgical team was exceptional, and my subsequent inpatient care was professional and appropriate. In fact, the immediate care I received in the ED was thorough and appropriate. The issue lies at the system level: a structural mismatch between patient needs and operational realities.
Hospitals operate under immense pressure: staffing shortages, rising patient volumes, and finite resources. ED boarding is often a symptom of these broader constraints. But normalization of the practice does not make it benign.
If anything, its prevalence makes it more urgent to examine. What is the threshold at which capacity challenges begin to compromise safety? How are decisions made about who waits and where? And how do hospitals reconcile these realities with their stated commitments to patient dignity and quality care? These are not abstract questions. They are lived experiences for patients every day.
ED boarding is frequently discussed in operational terms: metrics, flow, bed management. It should also be discussed in human terms. What does it mean to recover in a chair? To manage pain in a crowded, noisy space? To have private conversations within earshot of strangers? To depend on persistence and assertiveness to access what should be standard care?
Health care systems are complex, and there are no easy solutions. But acknowledging the gap between current practice and intended standards is a necessary first step.
Because when a patient is admitted to a hospital, a bed should not feel like a privilege earned through advocacy. It should be a given.
Sarah Whaley is a patient advocate.
