Emergency department overcrowding continues to challenge hospitals in Massachusetts and across the United States, with patient boarding identified as a primary cause of congestion. Boarding occurs when admitted patients remain in the emergency department (ED) while waiting for inpatient beds, thereby limiting space for incoming emergency cases. In addition to boarding, elective admissions—scheduled hospitalizations for non-emergency procedures—also contribute to limited bed availability and extended wait times.

Drs. Jonathan Olshaker and Scott Weiner recently highlighted boarding and elective admissions as key factors driving ED delays. However, some experts argue that strategies to address elective admission scheduling have not been fully leveraged. Eugene Litvak, president and CEO of the Institute for Healthcare Optimization and adjunct professor at Harvard T.H. Chan School of Public Health, points to efforts in Massachusetts that successfully eased ED crowding by rescheduling elective surgeries to better align with bed availability.

Litvak cites a 2004 initiative at Boston Medical Center where elective surgery schedules were adjusted to prevent elective patients from occupying beds urgently needed by emergency admissions. This approach reportedly enabled the hospital to treat a higher volume of patients while decreasing waiting times and reducing ambulance diversions. According to Litvak, these scheduling changes are part of what is termed “smoothing” patient flow to optimize existing hospital capacity.

This concept is not new; it was formally recommended in a 2007 national report by the Institute of Medicine (now the National Academy of Medicine), titled “Hospital-Based Emergency Care: At the Breaking Point.” The report advised spreading elective admissions evenly throughout the week to reduce surges in demand and alleviate ED congestion.

While expanding bed capacity and increasing staff remain potential solutions, Litvak advocates for hospitals and health systems to first assess whether optimizing patient flow and adjusting elective admission patterns could recover capacity within the current system. He describes this approach as an overlooked but effective method to mitigate emergency department overcrowding without immediately resorting to more costly resource expansions.

As healthcare systems grapple with balancing scheduled procedures and emergency care needs, exploring operational improvements in admissions scheduling may offer a pathway to improving patient flow and reducing wait times in emergency departments.