Emergency Department Boarding and Crowding

ACEP Sounds the Alarm on Boarding as a Public Health Emergency

Staffing challenges and burnout exacerbate the crisis and perpetuate a dangerous and sometimes deadly cycle.

“Boarding” in the emergency department is a result of dangerous health system overload that puts patients in a holding pattern as they wait for an inpatient bed or transfer after their initial care.

These delays can last hours, days, weeks, or longer.

Whether part of ACEP's day-to-day work on behalf of its members or a more public event, ACEP leaders are constantly having meetings, conversations, emails and exchanges with all decision makers and stakeholders to help find solutions to this growing boarding crisis that impacts emergency physicians so greatly.

You Spoke, The Government Listened

Mobilizing hundreds of our members, ACEP took your boarding concerns to Capitol Hill during ACEP’s 2023 Leadership & Advocacy Conference. And just a few months later, your advocacy resulted in an HHS announcement to form a national boarding task force.

The Systemic Boarding Crisis

ACEP Summit on Boarding

ACEP organized the first national stakeholder summit on boarding in September 2023. Stakeholders across health care met in the ACEP DC office to collaborate on solutions.

The American Hospital Association (AHA) and America’s Essential Hospitals were represented at the Summit to hear firsthand the impact boarding is having on patients and physicians, and answer to the growing crisis.

Read the full report on the summit

In addition to urging hospital leaders and other stakeholders to address issues that contribute to boarding, ACEP has ALSO asked the federal government address boarding contributors, as well.

Our Boarding Policy Recommendations include, among others:

Call for new CMS Condition of Participation requiring hospitals to develop contingency plans when inpatient occupancy exceeds a threshold of ED bed capacity.
Modify CMS measure of "Median Time from ED Arrival to ED Departure for Discharged ED Patients" to create a bright line standard (for example, 4 hours) with a percentage performance.
Instead of sunsetting the measure in 2024, CMS must maintain the “Admit Decision Time to ED Departure Time for Admitted Patients” measure - one of the only measures available to provide incentives/enforcement to help reduce wait times and boarding.

ED Boarding: Frontline Stories

ACEP members are sharing stories about the impact of rising patient boarding, and the picture painted is bleak—emergency departments and hospitals are at a breaking point.

Read Their Stories Share Your Story

Advocacy

ACEP has been leading national efforts to address ED crowding and boarding for several decades. Currently we are advocating directly with the White House, bipartisan members of Congress, regulatory agencies, and other stakeholders involved in constructive approaches to alleviate the factors that lead to our nation’s boarding crisis.

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Boarding and Crowding Talking Points

Letter to the White House (November 7, 2022)

Regs & Eggs: Update on the ED Boarding Crisis

Pushing for Solutions to the Boarding Crisis

Brewing for years, the boarding crisis hit troublesome levels in late 2022. Your stories, filled with urgency and passion, allowed ACEP to launch a multichannel advocacy campaign.

Tackling the boarding crisis is one of the ways ACEP has your back.

Learn More

Policy Statements & Solutions

Research & Publications

Survival Tactics for Emergency Department Boarding (ACEP Now, March 2024)
An Actionable, Visual Dashboard Approach to Boarding (ACEP Now, December 2023)
Can an ED Psych Unit Decrease Hospital Admission And Boarding Time? (ACEP Now, May 2022)
Hospital-Wide Strategies for Reducing Inpatient Discharge Delays and Boarding (ACEP Now, July 2021)
Patient flow through the emergency department (R³ Report | Requirement, Rationale, Reference, The Joint Commission, Issue 4, December 19, 2012)
Association between boarding in the emergency department and in-hospital mortality: a systematic review (PLOS One, April 15, 2020 https://doi.org/10.1371/journal.pone.0231253)
Emergency Department Crowding: The Canary in the Health Care System (NEJM Catalyst, September 28, 2021)
Boarding Critically Ill Patients in the ED (Journal of the American College of Emergency Physicians Open, July 17, 2020 | DOI: https://doi.org/10.1002/emp2.12107)
Evolving Models in Caring for ICU Boarders (Annals of Emergency Medicine, July 08, 2020, DOI: https://doi.org/10.1016/j.annemergmed.2020.05.007)
US Performance on ED Throughput (2006-2016) (Annals of Emergency Medicine, April 14, 2021 DOI: https://doi.org/10.1016/j.annemergmed.2021.01.009)
Critical Care Delivery Solutions in the Emergency Department: Evolving Models in Caring for ICU Boarders (Annals of Emergency Medicine, July 08, 2020 DOI: https://doi.org/10.1016/j.annemergmed.2020.05.007)
The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Boarding and And Crowding (Annals of Emergency Medicine, January 23, 2020 DOI: https://doi.org/10.1016/j.annemergmed.2019.12.002)
High Impact Solutions Report (American College of Emergency Physicians, Emergency Medicine Practice Committee, May 2016)