Where ED wait times are the longest

Long ED wait times are a consistent problem across the United States. In 2022, a fifth of ED visits had wait times longer than recommended for a patient's triage level. Although HHS and the Office of Disease Prevention and Health Promotion have aimed to reduce this figure to 12% by the end of the decade, progress so far has been limited.

Based on new CMS data, the average ED wait time across the United States is now 162 minutes, or over 2.5 hours. Washington, D.C., and Puerto Rico had the longest wait times at over five hours, followed by Maryland with a wait time of four hours and 11 minutes.

Most states (34) had ED wait times between two and three hours while 11 states had ED wait times between three and four hours. Only four states — Hawaii, North Dakota, South Dakota, and Nebraska — had wait times under two hours. 

How to reduce ED wait times

Long ED wait times, as well as ED boarding issues, are placing immense pressure on healthcare systems, worsening clinician burnout, and creating frustrating patient experiences. 

To help leaders address these challenges, Jennifer Puzziferro, a senior director at Optum Advisory*, proposed a range of practical and patient-focused solutions, each aimed at improving care delivery while reducing systemic pressures.

Within the hospital, several targeted interventions can optimize patient flow and help to alleviate capacity constraints. 

• Discharge preparation should begin immediately upon admission, with care teams setting an estimated discharge date to guide treatment plans and identify potential barriers early.
• Interprofessional rounds involving physicians, nurses, social workers, and care coordinators help create proactive treatment and discharge plans, and can identify needs for the actual discharge date, such as arranging transportation, prescriptions, and follow-up appointments.
• Diagnostic tests and imaging should be carefully scheduled, prioritizing those essential to the patient's care plan while deferring non-urgent procedures to outpatient settings to reduce over-testing and avoid bottlenecks.
• Implementing real-time bed management systems to monitor availability across units and expediting patient transfers from the ED can help hospitals move admitted patients into appropriate inpatient beds more quickly and reduce boarding. Expanding observation units can also create dedicated space for patients who need short-term monitoring without requiring full inpatient admission.
• Deploying Patient Flow Specialists to focus on streamlining complex discharges and coordinating resources can address logistical challenges, such as mobility aids or post-discharge care. 

By refining these internal processes, hospitals can reduce delays and create an environment that supports both efficient operations and positive patient outcomes.

Healthcare organizations also have several opportunities to improve patient throughput outside of the hospital environment, including home-first initiatives, hospital-at-home programs, and paramedic programs.

New advancements in technology can also enhance operational efficiency and patient care. Telehealth platforms and virtual urgent care visits divert non-critical cases from the ED.  AI-powered triage systems prioritize patients based on urgency, ensuring optimal care delivery. Wearable technology, remote patient monitoring, and smart ambulances facilitate earlier interventions and personalized care external to the hospital environment. Additionally, predictive analytics tools can improve capacity planning and early identification of patient needs, while mobile health apps empower patients with real-time information and scheduling options.

Overall, "systemic reforms are necessary and require sustained effort and investment to create a healthcare model that better supports clinicians, minimizes inefficiencies, and delivers high-quality, safe patient care," Puzziferro said.

*Advisory Board is a subsidiary of Optum. All Advisory Board research, expert perspectives, and recommendations remain independent.