State Approaches to Boarding and Crowding

As emergency departments throughout the country deal with the problems of crowding, boarding and ambulance diversion, some chapters have sought relief through state legislative and regulatory action. The resources on this page provide examples of these state legislative and regulatory approaches.  Additional crowding resources are available in ACEP's Practice Resources area.

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A 2011 letter from the Pennsylvania Department of Health to hospitals regarding boarding and crowding.


Guidelines to assist hospitals in developing policies and procedures for boarding admitted patients.


These two resolutions approved by the state medical societies in Texas and New Mexico are prime examples of how chapters can enlist the support of the larger medical community within their states to actively support meaningful efforts to address boarding problems.


An information paper developed by the 2008-2009 State Legislative/Regulatory Committee with information from ACEP chapters about local programs and state legislative initiatives designed to address problems associated with boarding and crowding.


A 2009 letter addressing hospital fire protection and evacuation plans relative to the ongoing problems of hospital emergency department crowding and patient boarding.


A 2009 guidance on reducing or eliminating the need for boarding patients in the emergency department during flu season.


A 2008 directive from the Massachusetts Department of Public Health prohibiting the practice of ambulance diversion except in extreme cases and instructing hospitals to improve patient flow practices to alleviate boarding of patients in the emergency department.


2009 California bill, passed by the legislature but vetoed by the governor, that would have implemented a full capacity protocol for hospitals when crowding issues reach pre-determined levels.


Guidance includes clear directions that maintaining admitted patients in the ED is not acceptable and that ambulance diversion should be used sparingly.


Provides background information and an explanation of the Massachusetts crowding bill that is also available in this section of the Web site.


Contents of a bill that would have required the Department of Health to establish a variety of guidelines to ensure that admitted patients are promptly moved to inpatient settings.


The chapter's testimony before a legislative committee on its boarding bill as well as on-call and reimbursement issues facing emergency medicine.


A 2004 letter from the New Jersey Department of Health instructing hospitals that they will be permitted to place patients in inpatient halls under certain circumstances.


A 2007 bill that would require admitted patients to be moved out of the emergency department within four hours of admission.


2006 Connecticut bill that would have required that admitted patients be moved out of the emergency department within eight hours of admission and require hospitals to monitor patient flows and develop plans to prevent diversion.


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