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.

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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


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

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Letter to the White House (November 7, 2022)

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Regs & Eggs: Update on the ED Boarding Crisis

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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.

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Research & Publications

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