A Moment to Lead

Hospital-at-home won’t single-handedly solve ED boarding, but it will inevitably reshape emergency medicine. We are at an inflection point—a chance for emergency physicians to extend our influence beyond hospital walls and into the evolving landscape of acute care. If we approach this moment with cautious optimism and a willingness to lead, emergency medicine can help make high-quality, equitable, and efficient hospital-at-home a reality. If emergency physicians remain passive, we risk being sidelined in the next era of acute care delivery.

With or without us, the home is becoming an extension of the ED. It’s time we identified ourselves as critical stakeholders in this discussion and claimed a seat at the table.

Dr. Zikry is an emergency physician and health services researcher; he is a scholar in the National Clinical Scholars Program at UCLA. His research interests revolve around incorporating acute, unscheduled care into health systems’ population health strategies, with a particular focus on novel and innovative disposition options such as virtual observation and hospital-at-home. His work has been featured in JAMA, Annals of Emergency Medicine, and Health Affairs.

Dr. Kilaru is an emergency physician and health services researcher at the University of Pennsylvania. His work focuses on transitions from emergency department care to outpatient services, innovation in delivery and financing of emergency care. His work has been featured in the New England Journal of Medicine, JAMA, JAMA Network Open, Health Affairs, and Annals of Emergency Medicine.

References

1. American Hospital Association. Fact Sheet: Extending the Hospital-at-Home Program. https://www.aha.org/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program. Published April 2025. Accessed July 15, 2025.
2. Levine DM, Ouchi K, Blanchfield B, et al. Hospital-level care at home for acutely ill adults: a randomized controlled trial. Ann Intern Med. 2020;172(2):77-85.
3. Edwards E, Thompson A. As ER overcrowding worsens, a program helping to ease the crisis may lose funding. NBC News. https://www.nbcnews.com/health/health-care/er-overcrowding-worsens-program-helping-ease-crisis-may-lose-funding-rcna135966. Published February 7, 2024. Accessed July 15, 2025.
4. Kilaru AS, Zikry HE. The role of emergency medicine in hospital-at-home. Ann Emerg Med. 2025:S0196-0644(25)00148-9.
5. Clarke DV, Newsam J, Olson DP, et al. Acute hospital care at home: the CMS waiver experience. NEJM Catalyst. https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0338. Published December 7, 2021. Accessed July 15, 2025.
6. Advisory Board. How hospitals are tackling ED boarding problems. https://www.advisory.com/daily-briefing/2025/03/31/ed-overflow. Accessed July 15, 2025.
7. Zikry HE, Schriger DL, Kilaru AS. Hospital participation in the acute hospital care at home waiver program. JAMA. 2025;333(8):718-720.