How Long Can a Hospital Keep You on Hold?: A Guide to Patient Rights

September 30, 2025 •

3 min read

According to recent data from the Centers for Medicare & Medicaid Services, the median time patients spend in the emergency room has increased, signaling systemic challenges in healthcare. So, how long can a hospital keep you on hold before you have the right to demand information or seek other options?

Quick Summary

Hospitals cannot hold a voluntary patient indefinitely, but wait times vary greatly based on medical necessity, staffing, and bed availability. Wait times differ for emergency room patients, admitted patients waiting for a room, and those on observation status. Legal holds are an exception, but patients always retain specific rights.

Key Points

ER Wait Times: A hospital's triage system prioritizes patients based on the severity of their condition, which means those with less critical issues may face long waits.
Inpatient Boarding: Even after an admission decision is made, patients often wait for an inpatient bed to become available, a process known as boarding.
Observation Status: This is an outpatient status, even if you stay overnight, and can have significant financial implications regarding Medicare coverage and costs.
Voluntary vs. Involuntary Hold: A voluntary patient can leave the hospital against medical advice (AMA), but those on an involuntary psychiatric hold are legally detained for a specific period, such as a 72-hour hold for evaluation.
No Financial Holds: Due to federal laws like EMTALA, hospitals cannot hold a patient or deny them emergency care based on their ability to pay.
Know Your Patient Rights: You have the right to know your care status, participate in discharge planning, and communicate with staff about concerns over wait times.
Appeal Discharge Decisions: Medicare patients who believe they are being discharged prematurely can appeal the decision with a Quality Improvement Organization (QIO).

The Waiting Game: Understanding Hospital Delays

When a patient arrives at a hospital, particularly the emergency room (ER), their wait time is influenced by several factors beyond their control. Delays are not always a sign of negligence but are often the result of resource constraints and the prioritization of more critical cases through a process known as triage. Triage ensures that those with life-threatening conditions, such as a heart attack or severe bleeding, are seen immediately, while less severe cases wait.

Factors Influencing Long Wait Times

The reasons behind extended wait times are complex and multifaceted. These include high patient volumes, inadequate staffing, the need to prioritize critical emergencies, inefficient patient flow for testing and medication, lack of available inpatient beds (boarding), and delays in discharge processes.

The Critical Difference: Inpatient vs. Observation Status

One of the most confusing aspects of a hospital stay is the distinction between inpatient and observation status. Patients can be placed in a bed and stay overnight under observation but are legally considered outpatients. This distinction can have significant financial consequences, especially for Medicare recipients.


Aspect	Inpatient Status	Observation Status
Clinical Purpose	For patients who require complex or longer care, expected to stay over two midnights.	For short-term monitoring (usually < 48 hours) to determine if inpatient admission is needed.
Medicare Part	Covered by Medicare Part A.	Covered by Medicare Part B.
Patient Financial Impact	Typically a one-time deductible for the entire stay.	Can lead to higher costs, including copayments for each hospital service and costs for self-administered drugs.
Notice Requirement	Not required for admitted inpatients.	Hospitals must provide a Medicare Outpatient Observation Notice (MOON) if observation lasts >24 hours.
Skilled Nursing Facility (SNF) Eligibility	Three consecutive inpatient days required to trigger Medicare coverage for subsequent SNF care.	Days under observation do not count toward the 3-day requirement for SNF coverage.

Understanding Involuntary Holds and Your Rights

For a general medical issue, a hospital cannot keep you against your will. However, there are legally defined situations where a patient can be placed on an involuntary hold, most commonly for psychiatric evaluation. State laws, such as California's '5150,' permit temporary 72-hour holds if an individual is deemed a danger to themselves or others or is gravely disabled due to a mental health disorder. These holds can end sooner or be extended after a hearing.

Voluntary patients have the right to leave at any time, even against medical advice (AMA). If you choose to leave AMA, you'll likely sign a form acknowledging the risks. It is illegal to hold a patient solely for financial reasons, as laws like EMTALA require stabilizing treatment for emergencies regardless of ability to pay.

What You Can Do During an Excessive Wait

If you experience an excessive wait time, you can take proactive steps. Inform the triage nurse if your condition changes, request updates and reasons for delays, clarify if you are on observation status, and utilize a patient advocate if needed. Medicare patients can appeal discharge decisions they believe are premature with a Quality Improvement Organization (QIO). For significant issues or harm caused by delays, you can file a complaint with the hospital or regulatory bodies like CMS.

Conclusion

Prolonged hospital wait times are common due to systemic factors. Voluntary patients generally cannot be held against their will, but involuntary holds have legal basis for specific reasons like psychiatric evaluation. Understanding the difference between inpatient and observation status is vital for financial and post-discharge care planning. Knowing your rights and communicating with staff can help navigate these situations.

To learn more about Medicare regulations, you can visit the Centers for Medicare & Medicaid Services (CMS) website.

Frequently Asked Questions

Generally, if you are a voluntary patient, you have the right to leave against medical advice (AMA). The hospital may require you to sign a form acknowledging the risks. However, you cannot leave if you are a threat to yourself or others, or if a court has declared you incompetent.

Inpatient status is for patients requiring more complex or long-term care and is typically covered by Medicare Part A. Observation status is an outpatient designation for short-term monitoring, generally covered by Medicare Part B, which can mean higher out-of-pocket costs and can affect eligibility for skilled nursing facility coverage.

ER wait times vary based on factors like patient volume, the severity of other emergency cases being treated, and staffing levels. Triage nurses prioritize the most critical patients, so those with less urgent issues will wait longer.

Yes, if a medical professional determines that you pose a danger to yourself or others due to a mental health disorder, you can be placed on a temporary involuntary hold (e.g., a 72-hour hold) for evaluation.

Yes, this is known as 'boarding.' After an admission decision is made, patients can wait for hours, or even days, in the ER for an inpatient bed to become available due to high hospital capacity.

This is illegal under the Emergency Medical Treatment and Labor Act (EMTALA). Hospitals are legally required to provide stabilizing treatment for emergency conditions regardless of a patient's ability to pay.

You can first address your concerns with the hospital's patient advocate or liaison. For more formal complaints, you can contact your state's health department or file a grievance with the Centers for Medicare & Medicaid Services (CMS).