Emergency Medicine Crowding and Boarding

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As emergency departments throughout the country deal with the problems of crowding, boarding, and ambulance diversion, solutions have been sought. The resources on this page provide information, resources and examples of a variety of approaches to assist emergency physicians in addressing the crowding problems by working with hospital administrators, local stakeholders, policy makers and the public. Some ACEP chapters have sought relief through state legislative and regulatory action. These additional crowding resources are available in ACEP's Advocacy area.

Emergency Department Crowding: High Impact Solutions    

Information Paper - EM Practice Committee, May 2016

ACEP Sends Comments to The Joint Commission on Patient Flow New iconACEP supports the proposed definition, including the 4 hour timeframe, opinions among members are varied.

Jan. 19, 2012 

Associations Join Forces to Reduce ED Crowding
ACEP, ENA and seven other associations have signed a consensus statement that proposes standardized emergency department metrics to help reduce crowding and boarding in emergency departments. 

Consensus Statement: Definitions for Consistent Emergency Department MetricsNew icon

ACEP’s Suggested Boarding Solutions Generate National Support 
May 30, 2008

Crowding Case Studies 
Submit your case study for publication on ACEP.org.

 Related ACEP Policy Statements


Boarding of Admitted and Intensive Care Patients in the Emergency Department

Boarding of Pediatric Patients in the Emergency Department

Definition of Boarded Patient

Health Care System Surge Capacity Recognition, Preparedness, and Response

Responsibility for Admitted Patients

Writing Admission and Transition Orders


Ambulance Diversion 
   PREP for above policy:
   Guidelines for Ambulance Diversion  


Emergency Ambulance Destination

Information Papers

Publishing Wait Times for Emergency Department Care, June 2012

Optimizing ED Front End Operations, February 2010

Approaching Full Capacity in the Emergency Department, October 2006

Meeting the Challenge of Emergency Department Overcrowding/Boarding, Report from a Roundtable Discussion, 2005

Emergency Department Crowding, March 2004

Emergency Department Operations Management, March 2004

 Comprehensive Guides

Perfecting Patient Flow: America’s Safety Net Hospitals and Emergency Department Crowding, 2005

State Approaches to Boarding and Crowding Resource Page

 Reference Articles

Crowding and Surge Capacity Resources for Emergency Departments, April 2007 
This paper includes 63 references to articles on ED Crowding and Quality of Care as well as Surge Capacity.

 Online Resources

Urgent Matters Program Toolkit on overcrowding

Managing Non-emergency Care in the Emergency Department

Emergency Departments: An Essential Access Point to Care. AHA TrendWatch, March 2001

Hospital overcrowding resources. Created by Peter Viccellio, MD, FACEP


Related ACEP Scientific Assembly presentations

Hospital-Wide Patient Flow: Cracking the Code (SU-113) , 2011 
Faculty: Kirk B. Jensen, MD, MBA, FACEP

Improving Front-End ED Flow: Successful Change Management (SU-76) , 2011 
Faculty: Kirk B. Jensen, MD, MBA, FACEP

Practical Patient Flow Solutions (TH-178) , 2010 
Faculty: Kirk B. Jensen, MD, MBA, FACEP

Best Practices: From Chaos to Consensus (TH-248), 2007 
Faculty: James J. Augustine, MD, FACEP

Reducing Time-to-Provider: Successful Implementation Secrets (TH-291), 2007 
Faculty: James J. Augustine, MD, FACEP


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