CHA Continues To Advocate for Action on Root Causes Driving Emergency Department Boarding and Throughput Challenges

Hospitals across Connecticut are actively identifying and implementing strategies that keep emergency department (ED) boarding rates down, while also advocating for action to address the root causes.  Boarding is defined as when a patient waits more than four hours for an inpatient bed after an admission decision.

The Connecticut Hospital Association (CHA) has submitted to the General Assembly’s Public Health Committee its second annual ED Boarding and Crowding Report — pursuant to Public Act 24-4, An Act Concerning Emergency Department Crowding (now codified at Section 19a-490ii of the Connecticut General Statutes).  The new report, which examines statewide data collected during calendar year 2025 and offers recommendations, highlights that hospitals continue to refine processes within their control and emphasizes the critical need to address the root causes that drive boarding, including persistent external factors that create significant throughput challenges for hospitals. 

Within hospitals, efforts are consistently underway to enhance triage processes, fast-track pathways for lower-acuity patients, implement temporary observation units, and adopt new approaches that allow care to begin earlier in the visit.  These steps improve patient flow for the majority of patients and support more efficient, streamlined admissions when inpatient care is needed.

However, many of the most significant drivers of extended hospital stays, which strain the ability to move patients through and out of the hospital, are persistent, systemic constraints that require legislative and cross-agency solutions.  External factors that directly contribute to prolonged ED boarding include: Medicaid underfunding and long-term care application delays, prior authorization requirements, housing instability, limited behavioral health resources, and challenges supporting patients with complex discharge needs.  When hospitals cannot safely discharge patients or secure appropriate placements, they cannot free up beds for those waiting in the ED — leading to throughput challenges.

While ED boarding and crowding are not new issues, too few state resources have been devoted to helping resolve the root causes.  Hospitals remain committed to continuous improvement, but lasting progress will require coordinated action with state partners and across the healthcare continuum.  Investments such as increasing Medicaid reimbursement rates and expanding community-based services are critical to ensuring timely, appropriate care for all patients.

Click here to read the report.